REV.CHIM.(Bucharest)♦70♦No.1♦2019 http://www.revistadechimie.ro 211 Effectiveness of Levonorgestrel - Releasing Intrauterine System in Perimenopausal Bleeding FLAVIUS OLARU 1 , CONSTANTIN OLARU 1 *, VIVIANA OLARU 2 , LAURA NUSSBAUM 3 *, LAVINIA HOGEA 3 , ROXANA FOLESCU 4 , MIRELA GRIGORAS 4 , ALINA MIHAELA PASCU 5 , VLADIMIR POROCH 6,7 *, DRAGOS ERDELEAN 1 1 Victor Babes University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, Dr. D. Popescu Hospital, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania 2 Victor Babes University of Medicine and Pharmacy, Department of Plastic and Reparatory Surgery, SCJUT, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania 3 Victor Babes University of Medicine and Pharmacy, Department of Neurosciences, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania 4 Victor Babes University of Medicine and Pharmacy, Department of Anatomy and Embryology, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania 5 Transilvania University of Brasov, Faculty of Medicine, 29 Eroilor Blvd, 500036, Brasov, Romania 6 Grigore T. Popa University of Medicine and Pharmacy, Faculty of Medicine, 16 Universitatii Str., 700115, Iasi, Romania 7 Regional Institute of Oncology, 2-4 G-ral Berthelot Str., 700483, Iasi, Romania The study aimed to compare the effectiveness of conservative methods [Levonorgestrel (C 21 H 28 O 2 ) – releasing intrauterine system (52 mg), endometrial ablation, hysteroscopy] vs. hysterectomy in perimenopausal bleeding. The study population was represented by 270 women addressed to Genesiun Clinic between 2010-2018 for perimenopausal bleeding because of different pathological circumstances: endometrial hypertrophy, polyps, uterine fibroids, endocervical lesions, chronic endometritis, intrauterine device (IUD)- related pathology, congenital abnormalities. The hysteroscopy is considered the method of choice in the diagnosis/therapeutic management of hemorrhagic metropathy. The hysteroscopic surgery was superior to hysterectomy, taking into account the postoperative complications and recovery, resumption of sexual activity and working. Levonorgestrel-releasing IUS 52 mg proved safe and efficient in treating metrorrhagia associated with endometrial dysplasia, uterine fibroids, and polyps. The bipolar electrosurgical VERSAPOINT system demonstrated good results in the treatment of intrauterine pathology. Our results pointed out the alternative of a surgery a few months after the hysteroscopy and endometrial ablation, and also the possibility of repeating the hysteroscopy procedure after a while, in some cases. Keywords: hysteroscopy, intrauterine device (IUD), Levonorgestrel ( C 21 H 28 O 2 ) , menorrhagia, perimenopausal bleeding *email: constantin_olaru@yahoo.com; nussbaumlaura@yahoo.com; vlader2000@yahoo.com Menorrhagia is a frequent reason for women to seek medical care, representing an increasingly common health problem. The Levonorgestrel (LNG) ( C 21 H 28 O 2 ) – releasing intrauterine system (IUS) is an effective medical treatment option for menorrhagia. Emerging clinical and research evidence suggests that this new treatment method has major health benefits [1-3]. The quality of life improves significantly being comparable to that gained by hysterectomy [4-8]. The costs are about half of those of hysterectomy after 1 year of follow-up. Unscheduled breakthrough bleeding is the most common side effect of the treatment. There are different new theories about the mechanism underlying this problem. Women with endometriosis or fibroids also benefit from this treatment [9-12]. Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs in order to provide the most appropriate care. The LNG ( C 21 H 28 O 2 ) -releasing IUS improves health- related quality of life significantly at relatively low cost. It is the most effective medical treatment for menorrhagia, comparable to surgical interventions. Although not all women are successfully treated, about 60% avoid hysterectomy and are satisfied with the treatment. Thus, the LNG ( C 21 H 28 O 2 ) -releasing IUS should be the first line treatment for heavy menstrual bleeding, as the system is not associated with serious complications [13-16]. Although hysterectomy has been considered as the golden standard treatment choice for menorrhagia, 50% of referrals to hospital ending to hysterectomy, the risk of complications is high. This is why the medical treatment should be reconsidered as a first line therapy and before referral to a specialist, the LNG ( C 21 H 28 O 2 ) - releasing IUS should be tried whenever there are no contraindications. Using LNG - releasing IUS (52 mg), the incidence of hysterectomy curettage, surgical sterilization, and oral contraceptives is lower [17-19]. LNG ( C 21 H 28 O 2 ) -releasing IUS 52 mg and endometrial ablation represent two alternative and conservative methods to the hysterectomy in menorrhagia treatment. The study aimed to compare the effectiveness of LNG (C 21 H 28 O 2 ) -releasing IUS 52 mg, as a conservative method for perimenopausal bleeding control, compared to other conservative methods (hysteroscopy, endometrial ablation) and to hysterectomy. The main monitored parameters were the postoperative complications, the postoperative recovery, the catamenial characteristics and other symptoms, and also the satisfaction of patients treated after one, six and twelve months. Experimental part Material and Methods The subjects of this study were 270 women aged 35 to 49, with heavy menstrual bleeding caused by different