The Levonorgestrel Intrauterine System Is an Effective Treatment in Selected Obese Women with Abnormal Uterine Bleeding

Objective: To evaluate the use of the levonorgestrel intrauterine system (LNG-IUS) in obese premenopausal women with abnormal uterine bleeding (AUB). Design: Prospective observational study (Canadian Task Force Classification II-2). Setting: University-affiliated teaching hospital. Patients: Fifty-six obese women with body mass index (BMI) >30 kg/m(2). Interventions: From January 2002 through September 2009, 56 obese patients (BMI >30 kg/m(2)) with abnormal uterine bleeding (AUB) were identified from the senior author's clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. Measurements and Main Results: The median and (range) for age, parity, and BMI were 42.5 years (20-64), 2 children (0-6), and 41.2 kg/m(2) (30-61), respectively. Many patients had additional comorbid conditions placing them at high risk for traditional medical or surgical therapies. The initial endometrial biopsy result was normal in 46 women (82.1%). Three women (5.4%) had inadequate sample, three (5.4%) had simple endometrial hyperplasia, two (3.6%) had complex endometrial hyperplasia without atypia, and two women (3.6%) had complex endometrial hyperplasia with atypia. After placement of the LNG-IUS, all women reported menstrual blood reduction at 3 and 6 months. The LNG-IUS was expelled in 2/56 patients (3.6%) and removed in 12(21.4%), and a new device was inserted in 3/56 patients (5.4%). At median follow-up of 48 months (range 3-72), the satisfaction rate was 75%. Conclusion: In properly selected obese women with AUB, the LNG-IUS is an effective therapy in approximately 75% of cases. Journal of Minimally Invasive Gynecology (2011) 18, 75-80 (C) 2011 AAGL. All rights reserved.