Levonorgestrel-Releasing Intrauterine System Improves Menorrhagia-Related Quality of Life in Patients with Symptomatic Adenomyosis
Levonorgestrel-Releasing Intrauterine System Improves Menorrhagia-Related Quality of Life in Patients with Symptomatic Adenomyosis
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DOI：
10.1007/s43032-022-01077-9
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发表时间：
2022-09-07
影响因子：
2.9
通讯作者：
Osuga, Yutaka
中科院分区：
文献类型：
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作者：
Ishizawa, Chihiro;Hirota, Yasushi;Osuga, Yutaka
左炔诺孕酮宫内缓释系统（LNG-IUS）可缓解子宫腺肌病患者的痛经和月经大出血（HMB）。然而，其对症状性子宫腺肌病患者健康相关生活质量（HR-QOL）的疗效尚不清楚。月经过多多属性量表（MMAS）通过HMB治疗测量HR-QOL改善，从未用于评估症状性子宫腺肌病患者的月经过多特异性HR-QOL。因此，本研究旨在使用MMAS研究LNG-IUS改善这些患者月经过多特异性HR-QOL的疗效。参与者通过磁共振成像进行诊断。我们还评估了LNG-IUS治疗前和治疗期间月经过多特异性HR-QOL、血红蛋白水平和痛经程度之间的关系。LNG-IUS治疗改善月经过多特异性HR-QOL在早期型子宫腺肌病中的效果优于晚期型子宫腺肌病。LNG-IUS治疗初发型痛经的视觉模拟量表评分优于晚期型。LNG-IUS治疗后，晚期型血红蛋白水平无明显改善，而早期型血红蛋白水平明显改善。此外，痛经和HMB相关性贫血与HR-QOL损害相关，LNG-IUS治疗可能通过缓解症状改善HR-QOL。总之，晚期子宫腺肌病降低了LNG-IUS对HR-QOL的有效性。因此，应加强磁共振成像的使用，以预测LNG-IUS在改善子宫腺肌病患者HR-QOL方面的疗效。
Levonorgestrel-releasing intrauterine system (LNG-IUS) relieves dysmenorrhea and heavy menstrual bleeding (HMB) in adenomyosis. However, its efficacy on health-related quality of life (HR-QOL) in patients with symptomatic adenomyosis remains unclear. The menorrhagia multi-attribute scale (MMAS), which measures HR-QOL improvement through the treatment of HMB, has never been used for evaluating menorrhagia-specific HR-QOL in patients with symptomatic adenomyosis. Hence, this study aimed to investigate the efficacy of LNG-IUS in improving menorrhagia-specific HR-QOL in these patients using the MMAS. The participants were diagnosed by magnetic resonance imaging. We also assessed the relationships between menorrhagia-specific HR-QOL, blood hemoglobin levels, and the degree of dysmenorrhea before and during LNG-IUS treatment. The LNG-IUS treatment improved the menorrhagia-specific HR-QOL more effectively in incipient type adenomyosis than in advanced type adenomyosis. The efficacy of LNG-IUS treatment on dysmenorrhea evaluated by the visual analog scale score tended to be better in the incipient type than in the advanced type. By the treatment of LNG-IUS, the blood hemoglobin level was not improved in the advanced type but in the incipient type. Furthermore, dysmenorrhea and HMB-related anemia were associated with HR-QOL impairment, and LNG-IUS treatment may improve the HR-QOL by relieving the symptoms. In conclusion, the effectiveness of LNG-IUS on HR-QOL is decreased by advanced adenomyosis. Thus, magnetic resonance imaging use should be reinforced to predict LNG-IUS efficacy in improving the HR-QOL of patients with adenomyosis.