Adenomyosis
Conditions
Keywords
Adenomyosis, Contraceptive pills, Levonorgestrel-releasing Intrauterine System
Brief summary
This study aims to compare the efficacy of LNG - IUD (Levonorgestrel releasing intrauterine device) Versus Low dose COCs (combined oral contraceptive pills) on management of heavy menstrual bleeding and Dysmenorrhea caused by Adenomyosis.
Detailed description
Levonorgestrel releasing intrauterine device will be MetraPlant-E, which is used in this study in group A, is a modified Levonorgestrel -releasing intrauterine system from the old IUD - Intrauterine Device Metraplant, MetraPlant-E design has a T-shaped frame containing Levonorgestrel and Ethylene Vinyl Acetate as well as Barium Sulphate to make it radio-opaque, All the T frame, the bulb of 20 mm length and sleeves contain: Ethylene Vinyl Acetate, Levonorgestrel and Barium Sulphate, which ensures more exposure of the endometrial surface to the system and hence expected more endometrial suppression. It consists of Levonorgestrel Hormone (60 mg), Ethylene Vinyl Acetate (120 mg) & Barium Sulphate (20 mg) Metraplant-E is designed without any coat membrane, which will help in more rise in Levonorgestrel level (higher initial release). The high initial release of Levonorgestrel (reached more than 28µg/24hrs in Metraplant-E in this study of in-vitro release) may help in early stoppage of bleeding in patients who suffer from irregular bleeding. Women in group A will receive IUD - Intrauterine Device- during menstruation .It will be inserted into uterus in similar procedure to non-hormonal IUD .Pelvic exam will be done, the vagina will hold open with speculum, grasping the cervix, measuring uterine length and proper insertion of IUD - Intrauterine Device by non-touch technic. Women will receive proper antibiotics after insertion. Group B will receive combined oral contraceptive pills (Yasmin) which will be Monophasic pills have a constant dose of both estrogen and progestin in each of the hormonal active pills throughout the entire cycle . Yasmin (ethinyl estradiol 0.03 mg/ drospirenone 3 mg) tablets, it provides an oral contraceptive regimen, it will be used continuously for 6 months with stoppage after 3 months for withdrawal bleeding. Both treatment arms (Metraplant E and Yasmin) will be followed up after 3 months and 6 month of patients' recruitment. Assessment of pain related symptoms will be done using visual analogue scale pain score, while assessment of menstrual improvement will be done using menstrual diary.
Interventions
DRUGYasmin
(ethinyl estradiol 0.03 mg/ drospirenone 3 mg) tablets
DEVICEMetraplant-E
Levonorgestrel-releasing Intrauterine System modified levonorgestrel-releasing intrauterine system from the old IUD Metraplant, modified by Azzam 2013
Sponsors
Ain Shams Maternity Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Women patient aged 30-45 years * Diagnosed adenomyosis by transvaginal ultrasound or MRI or 3D ultrasound * Patient complains of heavy menstrual bleeding or dysmenorrhea or both * Living in a nearby area to make follow-up reasonably possible * Planning for birth spacing for at least 2 years.
Exclusion criteria
* Pregnancy or seeking fertility * Severe underlying comorbidities (hepatic, oncological) * Pelvic inflammatory disease * Other cervical or uterine pathologies * Deep venous thromboembolism * Hormonal therapy contraindications * Endometriosis or fibroid
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of pain by pain measurement score | 6 Months | measurement of the pain score by questionnaire form filled by patients. this questionnaire is evaluated by numbers corresponding to each answer chosen by patients |
| Number of bleeding days | 6 Months | number of bleeding days is reported by patients and compared to pre- treatment conditions to evaluate the bleeding painful process duration and whether the intervention treatment had any relieving effect |
Countries
Egypt
Contacts
Primary ContactAsmaa Ma Mohamdy, Bachelor
Backup ContactMohamed Es Abbas, Lecturer
Outcome results
None listed