Uso do sistema intrauterino de levonorgestrel e o impacto na qualidade de vida de pacientes com sangramento uterino anormal

Abstract

Introduction: Hormonal intrauterine devices, known as the Levonorgestrel-Releasing Intrauterine System (LNG-IUS), contain 19-norethisterone, which is a second-generation progestogen. Endometrial atrophy induced by LNG-IUS causes menstrual changes, especially at the beginning of its use, and usually improves over time, decreasing uterine bleeding. Abnormal uterine bleeding (AUB) is a common gynecological symptom that affects a large number of women of reproductive age, causing important impacts on the physical, social, emotional and material quality of a woman's life. Objectives: To assess contraceptive safety, menstrual bleeding profile, continuation of the method, presence of structural causes of heavy menstrual bleeding, and improvement in the quality of life of patients with AUB, who underwent insertion of the LNG-IUS at a dosage of 52 mg. Methods: This is an analytical observational prospective cohort study that included patients with AUB who sought the gynecology outpatient clinic of the Cassiano Antonio Moraes University Hospital (HUCAM) for LNG-IUS insertion, from February 2018 to September 2021. Only women 18 years of age or older who had coitarche were included in the study. The women answered a standardized and validated questionnaire and underwent a transvaginal ultrasound examination. Medical record data were reviewed and analyzed using the IBM SPSS-23 statistical program. Results: A total of 51 patients with AUB participated in the study, of which 20 women had undergone bariatric surgery and 6 had hematological diseases. Structural causes were present in 25 patients (49%), and uterine fibroid was the most prevalent, present in 16 patients (31.3%). On ultrasound evaluation, the LNG-IUS was normally positioned in 43 patients (84.3%). The LNG-IUS expulsion rate was 11.8% (6 patients) and 35 patients (68.6%) continued to use the LNG-IUS. Amenorrhea occurred in 6 patients (17.1%) and menstrual bleeding volume became light in 24 patients (68.6%). As for the improvement in quality of life, 34 patients (97.1%) reported an improvement in the AUB and, consequently, a better quality of life. No patient became pregnant during the study. Conclusion: LNG-IUS has been shown to have great contraceptive efficacy and to be a good non-surgical therapeutic option for treating AUB, improving the quality of life of these women.