Análise crítica do sistema intra-uterino de liberação de levonorgestrel e do balão térmico como alternativas à histerectomia no tratamento do sangramento uterino anormal

Abstract

Heavy menstrual bleeding (HMB) is a prevalent symptom, bringing significant impact in quality of life and leading to high direct and indirect costs associated with treatment. Although highly effective, hysterectomy is associated with high costs and severe complications. Actually, minimally invasive methods are available. These techniques are minimally invasive, preserv the uterus, and show the potencial advantages of less morbidity, faster return to dayly activities, lower costs and fewer severe complications, but still present considerable failure rates. The aims of this review are: 1) to evaluate literature evidences about the efficacy, impact in quality of life, patient satisfaction, probability of hysterectomy avoidance and possibility to indicate the best method; 2) to compare the long term results of treatment of HMB with levonorgestrel releasing intrauterine system (LNG-IUS) and with thermall balloon endometrial ablation (TBEA); 3) to estimate the direct and indirect costs of the LNG-IUS,,the TBEA and hysterectomy in the treatment of HMB, including the costs of the failures and complications. A search was performed in Pubmed, Lilacs and Cielo databanks, from 1980 to 2012; a randomized controlled trial comparing the long term results of both LNG-IUS and TBEA was conducted and a comparative study of the treatment cost with LNG-IUS, TBEA and hysterectomy was performed. The results show that the LNG-IUS and endometrial ablation techniques have high efficacy, improve quality of life, have great satisfaction indices, and can reduce at least to the half the need for hysterectomy. In the long term comparison, the LNG-IUS performed better than TBEA as smaller hysterectomy rates, higher hemoglobin levels, minor blood loss and higher satisfaction rates were found. The overall costs of treating HMB with SIU-LNG were lower than with TBEA and hysterectomy. Taking all these issues into consideration, and highlighting the total reversibility and fertility preservation, the LNG-IUS seems to have more positive aspects, accrediting it as the first line treatment over TBEA and hysterectomy for HMB.