الفهرس 
Dysfunctional Uterine BleedingOnly 14 pages are availabe for public view
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Abstract
Introduction: Heavy menstrual bleeding (HMB), or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 ml per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dl). The levonorgestrel-releasing intrauterine system (LNG-IUS) has a variety of non-contraceptive benefits including treatment for menorrhagia, endometriosis, and endometrial hyperplasia. Metraplant-E, which is a new levonorgestrel-releasing intrauterine system used in this study, a new intrauterine system produced by Azzam 2013. Objective: to evaluate the therapeutic effect of the intrauterine system (Metraplant-E) in the treatment of dysfunctional uterine bleeding. Patients and Methods: 61 women attending the outpatient gynecology clinic at Ain Shams University Maternity hospital or the Early Cancer Detection Unit (ECDU) for hysteroscopy. Steps taken to include women in this study (women who are selected according to inclusion and exclusion criteria) by 1) taking thorough personal, menstrual and medical past history, 2) Pelvic ultrasonographic scan ordered for candidate women, 3) office hysteroscopy and endometrial biopsy done, 4) obtaining endometrial biopsy result, 5) treating cervicitis or PID or any suspected genital infection, 6) Metraplant-E insertion, 7) follow-up of women and 8) obtaining a second endometrial biopsy. Results: Metraplant-E, a new levonorgestrel-releasing intrauterine device made by Azzam, 2013 in its first clinical trial. At the end of the study: Total success rate was 49.18% (30 cases). The assessment of blood loss using pictorial assessment bleeding chart (PBAC) showed a decrease of the mean blood loss from 228.44 before insertion to 6.87 six months after Metraplant-E insertion (p=0.000), using bleeding index the mean was 22.94 before which decreased to reach 2.3 six months after insertion (p=0.000) and using the total bleeding score was 28.97 before insertion which decreased to reach 2.33 at six months after Metraplant-E insertion (p=0.000). The mean of the affection of quality of life scale (Likert scale) was 9.1 which improved six months after Metraplant-E insertion reaching 4.93 (p=0.000). All 15 cases who returned for follow-up has progesterone effect in histo-pathologic examination of follow-up endometrial biopsies The rate of spontaneous expulsion was 15 cases out of 61 participants equals about 24.59%.
Conclusions: “Metraplant-E” is a modified form of LNG-IUS (modified by Azzam from Metraplant) liberating ~ 20 micrograms per day. In this study Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathologic levels. However, further studies needed to be carried out to improve the efficacy and eliminate the side effects of the newly developed device (Metraplant-E). The greater risk for expulsion of intra-uterine device can be attributed to the severity of cases of dysfunctional uterine bleeding with the great amount of blood loss causing flushing out of the device, physical properties of the new device or late timing of insertion during the menstrual cycle.