This document discusses the role of Mirena, a levonorgestrel-releasing intrauterine system (LNG IUS), in treating heavy periods. It summarizes the author's experience with over 300 Mirena insertion cases and findings from studies on its effectiveness. Mirena is highly effective in reducing bleeding and provides better patient satisfaction than other medical or surgical treatments for heavy periods. It is also cost-effective and has emerging applications for conditions like endometriosis, fibroids and endometrial hyperplasia. The document outlines best practices for counseling patients and inserting Mirena.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
High cost involved in establishing and maintaining a good ART laboratory, the constant need to upgrade and adopt new technology and the use of stimulation protocols that use expensive drugs, makes ART treatment expensive.
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
High cost involved in establishing and maintaining a good ART laboratory, the constant need to upgrade and adopt new technology and the use of stimulation protocols that use expensive drugs, makes ART treatment expensive.
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
This MIRENA LAWSUIT updates provides context to growing number of Mirena Lawsuits by Attorney Gabriel F Zambrano one of the lawyers speaking out about the dangers of the Mirena IUD since July 2010.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...Lifecare Centre
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New development from France for Indian Gynaecologists & public to know :Dr Sharda Jain
CMV is a common herpesvirus that can infect people of all ages, including pregnant women.
CMV is not the same as HSV (herpes simplex virus), although they belong to the same viral family.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
How to Give Better Lectures: Some Tips for Doctors
Role of mirena in heavy periods
1. ROLE OF MIRENA IN
HEAVY PERIODS
DR. JYOTI BHASKAR
MD MRCOG
2. My Journey with LNG- IUS
Oman to Republic of Ireland to India
2001 -- 2010 --- 2013
3. My Journey with LNG IUS
• 2 – 4 cases of Hysterectomy/month
• 4-5 cases of Hysteroscopy/D&C/
Mirena Insertion per theatre
• 2-4 cases of Mirena Insertion / week
in OPD for contraception.
Cost of Mirena- 120 euros Paid by patient
4. Our Experience
• Over 300 cases Observed
• Inserted in 100 cases personally
• 70 for DUB, 30 for Contraception
5. My Journey with LNG IUS
• Inserted in unmarried girls, morbidly
obese, DM , HT patients.
• Women with Fibroids, adenomyosis,
endometriosis, complex hyperplasia.
• Not used in HRT patients.
6. My Journey with LNG IUS
• Amenorrhea in 40% after 1 year
• Reduction of bleeding in 90%
• 1 patient – absolute failure – removed
within 1 month.
• Irregular spotting was the main cause for
removal ( 20%)
• Significant Pain relief in post surgery
endometriosis
7. WHY MIRENA?
• Patient satisfaction
• Comparison with other techniques
• Emerging New Indications
• Cost Effective
• Ease of insertion and Removal
9. Bleeding pattern in the first 5-
year period
Rönnerdag M, Odlind V. Acta Obstet Gynecol Scand 1999;78:716–21
Infrequent
3.7% Regular
70.3%
Ammenorhea
26%
10. Mirena in the treatment of menstrual disorders:
a survey of UK patients' experience.
1056 patients – 1995-2003
• The majority 73% of women continued to use the Mirena.
• Women ranked their satisfaction with a mean score of
7.07/10.
• The commonest side-effect experienced was spotting
(19%).
• Less than 5% of the women required subsequent operative
treatment
J Obstet Gynaecol. 2008; 28(7):728-31
11. Comparison of Rx Modalities
LNG IUS
First-line treatment for menorrhagia
. Hormonal Method is acceptable
• Ongoing Treatment for more than 1 year is
anticipated
NICE GUIDELINES- CG44 Heavy menstrual bleeding:
2January 2007
12. Progesterones or LNG IUS
LNG IUS reduces menstrual blood
loss more effectively and has a
higher likelihood of treatment
success than oral
medroxyprogesterone acetate.
Levonorgestrel-releasing intrauterine system or medroxyprogesterone
for heavy bleeding Obstet Gynecol. 2010
13. Progesterone or progestogen-releasing
intrauterine systems for heavy menstrual
bleeding
• LNG IUS is more effective than cyclical
norethisterone (for 21 days) as a treatment
for heavy menstrual bleeding.
• Women with an LNG IUS are more
satisfied and willing to continue with
treatment but experience more side
effects, such as intermenstrual bleeding
and breast tenderness
Cochrane summaries ;November 10, 2010
14. Effectiveness and Cost-Effectiveness of
Levonorgestrel- Containing Intrauterine System in
Primary Care against Standard Treatment for
Menorrhagia (ECLIPSE) Trial
•14
LNG-IUS lead to greater improvement in women’s assessments of the effect of
heavy menstrual bleeding on their daily routine, including work, social and family
life, and psychological and physical well-being
NEJM
2013
15. LNG IUS vs Surgical Approach
SOURCES
• Surgery versus medical therapy for heavy menstrual
bleeding. Cochrane Database Syst Rev. 2006
• Levonorgestrel-releasing intrauterine system and
endometrial ablation in heavy Obstet Gynecol. 2009
• Hysterectomy, endometrial destruction, and levonorgestrel
releasing intrauterine BMJ. 2010
• The effect of hysterectomy or levonorgestrel-releasing
intrauterine system on sexual functioning among women
with menorrhagia: a 5-year randomised controlled trial.
BJOG. 2007
• The effect of hysterectomy or levonorgestrel-releasing
intrauterine system on BJOG. 2010
16. Surgery versus long term hormone treatment for‐
heavy menstrual bleeding
LNG IUS‐
• Improves the quality of life as
effectively as surgical treatment at 1
year
• It is more cost effective than
hysterectomy in the short term
This version published: 2010;
17. LNG vs Surgical Approach
• Surgical treatment is more effective
at reducing menstrual blood loss at 1
year
• Therapeutic results are comparable
at two years for endometrial ablation
18. LNG vs Surgical Approach
• Sexual function is better post-
hysterectomy although the risk of
urinary tract infections and stress
incontinence is higher
• Hysterectomy stopped all bleeding
but caused serious complications for
some women
19. Time to think again !!
• Hysterectomy:
• 40% morbidity rate
• 10 per 10,000 surgeries mortality rate
• In a recent survey of the outcomes of
37,000 hysterectomies, the overall
operative and postoperative
complication rates were 3.5% and 9%,
respectively
Reference: Dicker et al., 1982; Lilford R, 1997
20. LNG IUS versus Hysterectomy
•20
Percentage of women who cancelled their Hysterectomy when given the
option of LNG IUS in management of Menorrhagia
Pekka Lähteenmäki et al. 1998 316: 1122 (6)
23. Endometriosis
• Mirena after operative laparascopy for
endometriosis was more effective compared to
the group that was only treated surgically.
• Comparing use of GNRH analog to Mirena:
equally effective in reducing chronic pelvic pain.
The analogue was superior in reducing the
amount of blood flow.
Human Reproduction 2005
24. Use of LNG IUS for recurrence of symptoms in
women who have surgery for endometriosis
There is limited but consistent
evidence showing that postoperative
LNG-IUD use reduces the recurrence
of painful periods in women with
endometriosis
Cochrane summaries :Published Online:
January 31, 2013
26. FIBROIDS
• Use of the LNG-IUS appears to lead to a
significant reduction in the uterine
volume of women with menorrhagia
• Reduces the MBL in women with uterine
leiomyomas.
Efficacy of the levonorgestrel-releasing intrauterine system in
uterine leiomyoma.
Int J Gynaecol Obstet. 2012 Jan Kriplani A, Awasthi D, Kulshrestha V, Agarwal N.
27. Endometrial Hyperplasia
• Beneficial effects are observed by
the majority within 1 year.
• Treatment can be reliably monitored
through regular 6-montly outpatient
endometrial Pipelle surveillance
The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the
treatment of endometrial hyperplasia--a long-term follow-up study
Eur J Obstet Gynecol Reprod Biol. 2008
28. Early-stage Endometrial
Carcinoma
• Combined Operative HSC and LNG IUS for 12
months
• May have a role of safe and conservative
management of early EC
• In selected patients willing to preserve fertility
Conservative treatment of early endometrial cancer: preliminary
results of a pilot study.
Gynecol Oncol. 2011; 120(1):43-6
29. OTHER INDICATIONS
• In protection of endometrium from
endometrial hyperplasia during CCHRT
• Endometrial protection for women on
tamoxifen
• Women With Clotting Disorders Or Under
Anti Thrombotic Treatment
31. COUNSELLING
Is it not very costly as compared
to oral medication?
Doctor, I am spotting daily?
What do I do?
I have not had periods since 6
months? Am I in menopause?
33. Irregular Bleeding
• May last for 4-6 months
• Acceptance depends on good pre
insertion counselling
• Use COC or Progesterone to tide
over this period
• GnRHa too has a role
34. COST EFFECTIVENESS
LNG IUS
• Cost- Rs 8205/-
• Insertion cost – Rs.
2000/ Rs.5000
Covered by
Insurance
ORAL
PROGESTERONE
1 mnth – Rs. 3000
6 months Rs. 18000
1 Yr Rs. 36000
No insurance
35. SIDE EFFECTS
• Altered patterns of menstrual bleeding
• Hormonal symptoms
• Ectopic pregnancy – 1 in 20
• Uterine expulsion ( 1 in 20)
• Perforation ( 1-2/1000)
• Ovarian cysts
• Pelvic Infection
36. Insertion tips
• Screening for STI, Cervical
Screening
• Antibiotic Coverage( Optional)
• Insertion Tip – tighten and then
LOCK
37. DURATION
Menorrhagia:
It can be removed at mid 50s as long
as it controls the bleeding
HRT
Change it after 4 years “licenced”
38. Mirena after five years
• Contraception:
-<45years…..5 years
->45 years ….7 years
NICE GUIDELINES : “if inserted >45 and has
complete amenorrhea may continue to use it until
menopause”
40. EXTRA TIPS
• Not be used as Emergency
Contraception
• Can be used with ATT
• No effect on BMD
41. PROMISING NEW LNG IUSPROMISING NEW LNG IUS
• LNG-IUS12 and LNG-IUS16
• For Nulliparous and Postmenopausal
• Phase III trial results are now being analyzed and
"hopefully they will be ready soon."
Fertil Steril 2012.
42. •42
Effective alternative to
Surgery
Preserves Fertility
Convenient
Highly effective in reducing blood loss
Well Tolerated
High User Satisfaction
LNG IUS In
Menorrhagia
Take Home Messages!!!!
New
Indications
43. Mirena is a new horizonMirena is a new horizon
to your patient and yourselfto your patient and yourself
BE BOLD, WALK ALONG NEW PATHS
EXPERIENCE IT YOURSELF
44. ADDRESS
35 , Defence Enclave, Opp. Preet Vihar
Petrol Pump, Metro pillar no. 88, Vikas
Marg , Delhi – 110092
CONTACT US
011-22414049, 42401339
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
&