3-YEAR FOLLOW-UP OF THE USE OF A LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN HORMONE REPLACEMENT THERAPY

Background. The efficacy of a levonorgestrel-releasing intrauterine sy stem in opposing endometrial proliferation and in preventing bleeding was studied in peri- and postmenopausal women receiving estrogen repla cement therapy. Methods. This was an open, non-controlled follow-up st udy of the use of a levonorgestrel-releasing intrauterine system durin g continuous estrogen replacement therapy carried out by using oral, t ransdermal or subdermal estradiol. The efficacy of the progestin thera py was evaluated by transvaginal ultrasonography and by examination of endometrial biopsy samples taken 20 months (mean, range 17-22; first evaluation) and 34 months (mean, range 31-38 months; second evaluation ) after insertion of the levonorgestrel-releasing intrauterine system, and by studying patterns of bleeding. Twenty-five women participated in the first evaluation, and 29 in the second. Results. Seventy-six pe rcent of the women were amenorrheic at the first evaluation, and 79% a t the second evaluation. Others had spotting for 1-2 days monthly or l ess often. The mean time until amenorrhea was reached was 6 months (ra nge 2-13 months) after insertion of the levonorgestrel-releasing intra uterine system. The median endometrial thickness assessed by ultrasoun d was 2 mm at both evaluations. No signs of proliferation were observe d in any of the endometrial samples. Conclusions. Local progestin deli very via a levonorgestrel-releasing intrauterine system was effective in suppressing the endometrium and in eliminating bleeding in women re ceiving estrogen replacement therapy, and the intrauterine progestin t herapy was also well accepted.