Eficacia y seguridad del endoceptivo de levonorgestrel y leuprolide en el tratamiento del sangrado menstrual abundante por mioma
Fecha
2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: El hospital Teodoro Maldonado atiende anualmente una media de 250 casos de leiomioma uterino (LU), 32% recibe tratameinto farmacológico. El sangrado Menstrual Abundante (SMA) es el síntoma más relevante. Los tratamientos más empleados son dispositivo intrauterino de levonorgestrel (DIU-LNG) y leuprolide, sin que exista análisis de sus resultados. Objetivos: Establecer la existenica de diferencias en la eficacia y seguridad del DIU-LNG frente al leuprolide para SMA por LU. Metedología: Se realizó un estudio de casos y controles que incluyó aleatoriamente 46 casos de pacientes con SMA por LU tratados con leuprolide y 46 casos indicados con DIU-LNG. Se incluyeron pacientes sin carcinoma de cérvix, contraindicación al principio activo , posibilidad de acceso al expediente y seguimiento de al menos 6 meses. Se excluyeron paciente con enfermedad pélvica inflamatoria, neoplasia, antecedentes de tromboembolismo, embarazo y mioma submucoso con componente dentro de la cavidad > 50% Resultados: La mejora de la concentración de Hb 6 meses postratamiento fue ligeramente superior entre pacientes con leuprolide que en DIU-LNG, pero no significativa (37/42 vs 32/46; P > 0.05), lo mismo con el tamaño del mioma (19/46 vs 17/42; P > 0.05). Los niveles de hemoglobina (g/dl) no fueron significativamente mejores 6 meses después (12.26 + -1.66 vs. 12.24 +- 2.25; P 0.958), pero si en el tamaño de los miomas (mm) con DIU-LNG (19.74+- 11.18 vs. 27.44 +- 18.90; P0.020 corregido P 0.042) también disminuyo la dismenorrea 19/42 vs 30/42; P 0.022). Conclusión: DIU-LNG es más seguro y eficaz que Leuprolide para tratar SMA. Palabras Claves: Sangrado Menstrual Abundante. Leiomioma Uterino. Tratamiento. Leuprolide. Dispositivo intrauterino. Levonorgestrel.
Background: The Teodoro Maldonado hospital treats annually an average of 250 cases of uterine leiomyoma (LU), 32% receive pharmacological treatment. Abundant Menstrual Bleeding (HMB) is the most relevant symptom. The most used treatments are levonorgestrel intrauterine device (IUD-LNG) and leuprolide, without any analysis of their results. Objectives: To establish the existence of differences in the efficacy and safety of the IUD-LNG compared to leuprolide for SMA due to LU. Methodology: A case-control study was conducted that randomly included 46 cases of patients with BMS due to LU treated with leuprolide and 46 cases indicated with IUD-LNG. Patients without cervical carcinoma, contraindication to the active ingredient, possibility of access to the file and follow-up of at least 6 months were included. Patients with pelvic inflammatory disease, neoplasia, a history of thromboembolism, pregnancy and submucous myoma with a component within the cavity > 50% were excluded. Results: The improvement in Hb concentration 6 months after treatment was slightly higher among patients with leuprolide than with IUD- LNG, but not significant (37/42 vs 32/46; P > 0.05), the same with the size of the fibroid (19/46 vs 17/42; P > 0.05). Hemoglobin levels (g/dl) were not significantly better 6 months later (12.26 + -1.66 vs. 12.24 + - 2.25; P 0.958), but fibroid size (mm) with LNG-IUD (19.74+ - 11.18 vs. 27.44 +- 18.90, P0.020 corrected P 0.042) also decreased dysmenorrhea 19/42 vs 30/42; P0.022). Conclusion: IUD-LNG is safer and more effective than Leuprolide to treat SMA. Keywords: Heavy Menstrual Bleeding. Uterine leiomyoma. Treatment. Leuprolide. Intrauterine device. Levonorgestrel.
Background: The Teodoro Maldonado hospital treats annually an average of 250 cases of uterine leiomyoma (LU), 32% receive pharmacological treatment. Abundant Menstrual Bleeding (HMB) is the most relevant symptom. The most used treatments are levonorgestrel intrauterine device (IUD-LNG) and leuprolide, without any analysis of their results. Objectives: To establish the existence of differences in the efficacy and safety of the IUD-LNG compared to leuprolide for SMA due to LU. Methodology: A case-control study was conducted that randomly included 46 cases of patients with BMS due to LU treated with leuprolide and 46 cases indicated with IUD-LNG. Patients without cervical carcinoma, contraindication to the active ingredient, possibility of access to the file and follow-up of at least 6 months were included. Patients with pelvic inflammatory disease, neoplasia, a history of thromboembolism, pregnancy and submucous myoma with a component within the cavity > 50% were excluded. Results: The improvement in Hb concentration 6 months after treatment was slightly higher among patients with leuprolide than with IUD- LNG, but not significant (37/42 vs 32/46; P > 0.05), the same with the size of the fibroid (19/46 vs 17/42; P > 0.05). Hemoglobin levels (g/dl) were not significantly better 6 months later (12.26 + -1.66 vs. 12.24 + - 2.25; P 0.958), but fibroid size (mm) with LNG-IUD (19.74+ - 11.18 vs. 27.44 +- 18.90, P0.020 corrected P 0.042) also decreased dysmenorrhea 19/42 vs 30/42; P0.022). Conclusion: IUD-LNG is safer and more effective than Leuprolide to treat SMA. Keywords: Heavy Menstrual Bleeding. Uterine leiomyoma. Treatment. Leuprolide. Intrauterine device. Levonorgestrel.
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Menorragia, Leiomioma, Leuprolida, Levonorgestrel, Cumplimiento de la medicación, Estudio de casos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador