Isthmocele, Pelvic Pain, Post-menstrual Spotting Bleeding
Conditions
Keywords
isthmocele, postmenstrual spotting bleeding, pelvic pain
Brief summary
it was planned to investigate the treatment effect of levonorgestrel releasing intrauterine device in patient with isthmocele who were suffering from postmenstrual spotting bleeding and who had no desire for fertility.
Detailed description
isthmocele is an acquired diverticulum like defect of myometrium in the anterior isthmic part of uterus due to previous cesarean section incision. It can be defined as thinning of the incised site of uterus smaller than 50 % of its normal thickness. the real incidence is unknown. due to low ability of contractility of the postmenstrual spotting bleeding. Accumulation of blood in the isthmocele induces inflammation within the endometrium and causes pain as well. Furthermore, this inflammation can be an absolute reason for secondary infertility. As a result, accumulation of blood in the isthmocele seems to start up the cascade of morbidities. When understanding the mechanism, preventing blood accumulation seems to prevent symptoms other than infertility. Levonorgestrel releasing intrauterine devices can be a way of thinning the endometrium hence, blood accumulation can be avoided. In the literature, surgical correction of the isthmocele has been studied and medical treatment that was mentioned in the literature was the oral contraceptives and only a preliminary report of very small sample size, discussed the effect of levonorgestrel releasing device . in the light of aforementioned clinical knowledge, we planned to investigate the treatment effect of levonorgestrel releasing intrauterine device in patients with postmenstrual bleeding due to isthmocele who were not willing to have baby. These patients will be called back at 6th, 12th and 18th months after applying levonorgestrel releasing device to the uterus. Gynecological examinations will be done and complainants will be questioned.
Interventions
DEVICEusage of mirena ( levonorgestrel releasing intrauterine device) in isthmocele
usage of mirena ( levonorgestrel releasing intrauterine device) in isthmocele for postmenstrual spotting and do not have desire for fertility
DRUGLevonorgestrel Drug Implant Product
intrauterine administration
Sponsors
Gaziosmanpasa Research and Education Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
patients who have isthmocele due to previous cesarean section and suffering from postmenstrual spotting bleeding
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* having isthmocele and complaining for postmestrual spotting bleeding * having cesarean section as a last delivery way. * not planning for fertility * complaining about dysmenorrhea and pelvic pain
Exclusion criteria
* having pelvic infection * having an any type of previous pelvic surgery * having leiomyoma, endometrial polyp or adnexal mass * having any type of malignancy * having thyroid dysfunction and prolactinemia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| incidence of postmenstrual spotting bleeding | 18 months | incidence of vaginal spotting bleeding after normal menstrual bleeding |
| incidence of dysmenorrhea | 18 months | incidence of pelvic pain felt by the patient during mensturation |
| incidence of pelvic pain | 18 months | incidence of pelvic pain regardless of mensturation |
Countries
Turkey (Türkiye)
Outcome results
None listed