Estudo comparativo da ablação endometrial por balão térmico e sistemaintra-uterino de liberação de Levonorgestrel no tratamento do sangramentouterino anormal

Abstract

Introduction: Abnormal uterine bleeding affects 22% of women in menacme and near 20.000 are submitted to histerectomy each year in USA due to menorrhagia. The aim of this study is to compare the use of the levonorgestrel intrauterine system (LNG-IUS) and the thermal balloon ablation (TB) for the treatment of AUB. Methods: prospective randomised trial envolving 58 patients with AUB treated with the LNG-IUS (30) or TB (28). Inclusion criteria were patients older than 35 years who have completed childbearing, blood loss >80ml, uterine volume <200ccand without anatomical alterations of endometrial cavity. All patients underwent transvaginal ultrasound, endometrial biopsy, hemoglobin level and pregnant test prior treatment. The outcomes assessed were blood loss measured by a Pictorial Bleeding Assessment Chart (PBAC), bleeding pattern, and well-being status measured by Psychological General Well-Being Index. Comparisons between groups were performed by Repeated Measures ANOVA and t unpaired tests.Results: The age of the patients ranged between 35 and 52 years old (mean 42.8 ± 0.5). Both groups were associated to an increased of hemoglobin levels (p<0.001) and lower PBAC scores (p<0.001) one year after treatment. No significant differences were seing in comparison of the two groups. The LNG-IUS group showed a decrease in menstrual bleeding at 6 and 12 months post-treament when compared to TB (p=0.035; p=0.048 respectively). Intermenstrual bleeding were significantly lower in the TB at 6 months when compared to LNG-IUS group (p=0.044), with no differences at 12 months (p=0.129). Any difference occured in the PGWB index between the two groups (p=0.537). Conclusions: Both LNG-IUS and thermal balloon ablation showed efficacy in controlling heavy blood loss. The LNG-IUS was associated with less menstrual bleeding although higher intermenstrual bleeding, when compared to thermal ablation.