open access
Comparison of the efficacy of oral contraceptives and levonorgestrel intrauterine system in intermenstrual bleeding caused by uterine niche
Affiliations- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
- Department of Obstetrics and Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
open access
Abstract
This study aimed to compare the effectiveness of oral contraceptives and a levonorgestrel intrauterine system in treating intermenstrual bleeding due to uterine niche. We retrospectively analyzed 72 patients with intermenstrual bleeding due to uterine niche from January 2017 to December 2021, of whom 41 were treated with oral contraceptives and 31 with a levonorgestrel intrauterine system. Post-treatment follow-ups at 1, 3, and 6 months were conducted to compare the efficiency and adverse effects between the two groups. In the oral contraceptive group, the effectiveness rate was higher than 80% at 1- and 3-months post-treatment and higher than 90% at 6 months. In the levonorgestrel intrauterine system group, the effectiveness rates were 58.06%, 54.84%, and 61.29% at 1, 3, and 6 months of treatment, respectively. Oral contraceptives were more effective than the levonorgestrel intrauterine system in treating intermenstrual bleeding caused by uterine niche (p < 0.05).
Abstract
This study aimed to compare the effectiveness of oral contraceptives and a levonorgestrel intrauterine system in treating intermenstrual bleeding due to uterine niche. We retrospectively analyzed 72 patients with intermenstrual bleeding due to uterine niche from January 2017 to December 2021, of whom 41 were treated with oral contraceptives and 31 with a levonorgestrel intrauterine system. Post-treatment follow-ups at 1, 3, and 6 months were conducted to compare the efficiency and adverse effects between the two groups. In the oral contraceptive group, the effectiveness rate was higher than 80% at 1- and 3-months post-treatment and higher than 90% at 6 months. In the levonorgestrel intrauterine system group, the effectiveness rates were 58.06%, 54.84%, and 61.29% at 1, 3, and 6 months of treatment, respectively. Oral contraceptives were more effective than the levonorgestrel intrauterine system in treating intermenstrual bleeding caused by uterine niche (p < 0.05).
Keywords
efficiency; intermenstrual bleeding; levonorgestrel intrauterine system; oral contraceptives; uterine niche
About this articleTitle
Comparison of the efficacy of oral contraceptives and levonorgestrel intrauterine system in intermenstrual bleeding caused by uterine niche
Journal
Issue
Article type
Research paper
Published online
2023-07-06
Page views
647
Article views/downloads
250
DOI
Pubmed
Keywords
efficiency
intermenstrual bleeding
levonorgestrel intrauterine system
oral contraceptives
uterine niche
Authors
Fengque Zheng
Saiqiong Chen
Weiwei Yang
Jingjing Li
Qinxi Huang
Huayi Qin
Jiahan Wei
Jiajing Lin
References (33)- Pan H, Zeng M, Xu T, et al. The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study. Acta Obstet Gynecol Scand. 2019; 98(4): 413–422.
- van der Voet LL, Limperg T, Veersema S, et al. Niches after cesarean section in a population seeking hysteroscopic sterilization. Eur J Obstet Gynecol Reprod Biol. 2017; 214: 104–108.
- Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013; 20(5): 562–572.
- Antila RM, Mäenpää JU, Huhtala HS, et al. Association of cesarean scar defect with abnormal uterine bleeding: The results of a prospective study. Eur J Obstet Gynecol Reprod Biol. 2020; 244: 134–140.
- Bij de Vaate AJM, Brölmann HAM, van der Voet LF, et al. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011; 37(1): 93–99.
- Vervoort A, van der Voet LF, Hehenkamp W, et al. Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial. BJOG. 2018; 125(3): 326–334.
- Chen YY, Tsai CC, Kung FT, et al. Association between hysteroscopic findings of previous cesarean delivery scar defects and abnormal uterine bleeding. Taiwan J Obstet Gynecol. 2019; 58(4): 541–544.
- Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril. 2020; 113(4): 704–716.
- Chen YY, Tsai CC, Lan KC, et al. Preliminary report on the use of a levonorgestrel intrauterine system for the treatment of intermenstrual bleeding due to previous cesarean delivery scar defect. J Obstet Gynaecol Res. 2019; 45(10): 2015–2020.
- Ou YC, Chen YY, Lan KC, et al. Levonorgestrel intrauterine system for the treatment of intermenstrual spotting in patients with previous cesarean delivery scar defect. J Obstet Gynaecol Res. 2022; 48(1): 155–160.
- Zhang X, Yang M, Wang Q, et al. Prospective evaluation of five methods used to treat cesarean scar defects. Int J Gynaecol Obstet. 2016; 134(3): 336–339.
- Deng K, Liu W, Chen Y, et al. Obstetric and Gynecologic Outcomes after the Transvaginal Repair of Cesarean Scar Defect in a Series of 183 Women. J Minim Invasive Gynecol. 2021; 28(5): 1051–1059.
- Jordans IPM, de Leeuw RA, Stegwee SI, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol. 2019; 53(1): 107–115.
- Zou Z, Xiao S, Xue M. Clinical analysis of the preoperative condition and operative prognosis of post-cesarean section scar diverticulum: a case series. J Perinat Med. 2020; 48(8): 803–810.
- Piriyev E, Schiermeier S, Römer T. Laparoscopic Isthmocele (Niche) Correction as prevention in patients with fertility desire. Ginekol Pol. 2022; 93(12): 954–961.
- Zhang D, Liang S, Zhu L. Comparison of transvaginal repair versus laparoscopic repair of lower-segment cesarean scar defects. Int J Gynaecol Obstet. 2019; 145(2): 199–204.
- Zhang Y. A Comparative Study of Transvaginal Repair and Laparoscopic Repair in the Management of Patients With Previous Cesarean Scar Defect. J Minim Invasive Gynecol. 2016; 23(4): 535–541.
- Setubal A, Alves J, Osório F, et al. Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar. J Minim Invasive Gynecol. 2018; 25(1): 38–46.
- Vervoort AJ, Van der Voet LF, Witmer M, et al. The HysNiche trial: hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial. BMC Womens Health. 2015; 15: 103.
- Pomorski M, Fuchs T, Rosner-Tenerowicz A, et al. Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section. Ginekol Pol. 2017; 88(4): 174–179.
- Budny-Winska J, Zimmer-Stelmach A, Pomorski M. Two- and three-dimensional transvaginal ultrasound in assessment of the impact of selected obstetric risk factors on cesarean scar niche formation: the case-controlled study. Ginekol Pol. 2021; 92(5): 378–382.
- Budny-Winska J, Pomorski M. Uterine niche after cesarean section: a review of diagnostic methods. Ginekol Pol. 2021; 92(10): 726–730.
- Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009; 34(1): 85–89.
- Fabres C, Aviles G, De La Jara C, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003; 22(7): 695–700; quiz 701.
- Uppal T, Lanzarone V, Mongelli M. Sonographically detected caesarean section scar defects and menstrual irregularity. J Obstet Gynaecol. 2011; 31(5): 413–416.
- Alalfy M, Osman OM, Salama S, et al. Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women. Int J Womens Health. 2020; 12: 965–974.
- van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014; 121(2): 236–244.
- Bronner MH, Pate MB, Cunningham JT, et al. Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial. Ann Intern Med. 1986; 105(3): 371–374.
- van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990; 335(8695): 953–955.
- Thurmond AS, Harvey WJ, Smith SA. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 1999; 18(1): 13–6; quiz 17.
- Tahara M, Shimizu T, Shimoura H. Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar. Fertil Steril. 2006; 86(2): 477–479.
- Costanzi F, De Marco MP, Colombrino C, et al. The treatment with Levonorgestrel Releasing Intrauterine System (LNG-IUS) in patients affected by menometrorrhagia, dysmenorrhea and adenomimyois: clinical and ultrasonographic reports. Eur Rev Med Pharmacol Sci. 2021; 25(9): 3432–3439.
- Zethraeus N, Dreber A, Ranehill E, et al. Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab. 2016; 101(11): 4046–4053.
