Effects of the levonorgestrel-releasing intrauterine system on urinary symptoms in patients with adenomyosis Murat Ekin a , Huseyin Cengiz a, *, Mehmet Emin Ayag ˘ a , Cihan Kaya a , Levent Yasar a , Kadir Savan b a Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey b Medical Park Bahc ¸elievler Hospital, Istanbul, Turkey 1. Introduction Adenomyosis is a disorder characterized by the presence of endometrial islets within the myometrium situated at least 2.5 mm below the endometrial–myometrial junction. This disease appears in 2 forms – diffuse and focal – and typically involves the posterior uterine wall [1,2]. The common presenting symptoms of adenomyosis include painful and heavy periods with or without infertility, although many women are asymptomatic. Hysterecto- my or use of the levonorgestrel-releasing intrauterine system remains the mainstay of treatment [3]. The levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena 1 , Bayer Pharmaceuticals) contains a total of 52 mg of LNG (levonorgestrel) that is released at 20 mg a day for a recommended duration of 5 years. LNG released within the uterine cavity induces a potent block against the actions of estrogen upon the endometrium. Subsequently, menstrual bleed- ing is considerably reduced. There is currently a large of body of evidence that supports the safety, efficacy and acceptability of LNG-IUS as a form of contraception along with support for a variety of non-contraceptive benefits, including treatment for menorrha- gia [4–7]. All studies concerning adenomyosis and LNG-IUS have demonstrated a reduction in adenomyosis-related dysmenorrhea and menorrhagia following LNG-IUS treatment [6]. Moreover, the reduction in the amount of bleeding achieved by the LNG-IUS has been shown to be associated with improvements in the woman’s quality of life and overall satisfaction [8,9]. In a previous study, we observed an association between urinary tract dysfunction and adenomyosis and postulated that urinary symptoms related to adenomyosis may affect patients’ quality of life [10]. In the present study, we aimed to determine the effectiveness of LNG-IUS in ameliorating urinary symptoms and its effects on the quality of life (QOL) in women with uterine adenomyosis diagnosed by ultrasound examination. European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 517–520 A R T I C L E I N F O Article history: Received 11 February 2013 Received in revised form 3 July 2013 Accepted 11 July 2013 Keywords: Adenomyosis Intrauterine device Levonorgestrel Lower urinary tract symptoms Menorrhagia A B S T R A C T Objectives: We hypothesized that treatment of adenomyosis with the levonorgestrel-releasing intrauterine system (LNG-IUS) can concurrently improve urinary incontinence along with irritative and obstructive symptoms and thus positively affect the patients’ quality of life. Study design: Sixty-five patients suffering from heavy prolonged menstrual bleeding (menorrhagia) with dysmenorrhea diagnosed with uterine adenomyosis by ultrasound were enrolled in this study. LNG-IUS was inserted in the outpatient department for the treatment of the uterine adenomyosis. The patients filled out two validated questionnaires, the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7), before and 6 months after the insertion of the LNG-IUS. The before and after scores were compared using the non-parametric Mann–Whitney U test. Results: The mean (ÆSD) age of the patients was 44.5 Æ 6.5 years. Both UDI and IIQ scores were significantly lower at 6 months after treatment with the LNG-IUS (P < 0.0001). UDI scores revealed improvement rates of 14.3%, 35.7%, and 22.7% for urinary incontinence, irritative symptoms, and obstructive symptoms, respectively. Moreover, improvements in irritative and obstructive symptoms were significantly correlated with improvements in menorrhagia and dysmenorrhea (P < 0.04). IIQ scores demonstrated improvement rates of 18.9%, 14.6%, 19.7%, and 18.5% for physical activity, travel, social relations, and emotional health, respectively. Conclusions: LNG-IUS used for treating menorrhagia and dysmenorrhea improved urinary incontinence along with irritative and obstructive symptoms in patients with adenomyosis. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey. Tel.: +90 532 595 04 54; fax: +90 212 542 44 91. E-mail address: obstetrik@gmail.com (H. Cengiz). Contents lists available at SciVerse ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb 0301-2115/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejogrb.2013.07.019