THE CLINICAL EFFICACY OF SEQUENTIAL USE OF GONADOTROPIN-RELEASING HORMONE ANALOG - LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN MEDICALLY ILL WOMEN WITH SYMPTOMATIC AND RELATIVELY LARGE ADENOMYOSIS

Objectives: To evaluate the clinical outcome of sequential therapy of gonadotropin-releasing hormone (GnRH) analog, followed by the levonorgestrel-releasing intrauterine system in medically ill women with relatively large and symptomatic adenomyosis.Methods: A prospective cohorts study conducted in the Obstetrics and Gynaecology Department, Al-Yarmouk teaching hospital in Baghdad/Iraq from June 2016 to January 2018. 32 women, 40 years and above who complete their family and had significant medical disease along with symptomatic and relatively large adenomyosis (≥150 cm3) were included in the study. The primary outcome measure was to evaluate the clinical outcome of this sequential therapy in the form of improving menstrual blood loss and pelvic pain and the secondary outcome was decreasing uterine volume.Results: There were significant improvements in both menstrual blood loss volume and dysmenorrhea at the end of the 1st year with p˂0.001, mainly in the first 6 months. There were also significant reductions in the uterine volume (197.2±30.7–91.5±6.0 mm3). The expulsion rate was 15.6%.Conclusion: Sequential treatment protocol of GnRH agonist - LNG-IUS in symptomatic and relatively large adenomyosis (˃150 cm3) is effective in relieving symptoms and decreasing uterine volume with less possible expulsion rate, making the protocol good substitutions to surgery, especially in medically ill women were surgery carry more risk