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Aim: To evaluate the efficacy of levonorgestrel intrauterine system (LNG-IUS) treatment in patients with previous cesarean delivery scar defect (PCDS)-related intermenstrual bleeding., Methods: A total of six premenopausal patients who experienced PCDS-related intermenstrual bleeding were enrolled for conservative therapy with LNG-IUS (levonorgestrel 20 μg/24 h) insertion. The durations of menstruation before and after LNG-IUS insertion at 1, 6 and 12 months were recorded. A total of three missed menstrual cycles was defined as amenorrhea. Any side effects and the device expulsion rate were also recorded. Patient follow-up was at an outpatient clinic. Any missing data were obtained by telephone., Results: At the start of the study the median duration of intermenstrual bleeding was 6.5 days (range 3-22 days). After 6 months treatment, two of the six patients had developed amenorrhea and two patients experienced cessation of vaginal spotting. One patient reported expulsion of the device. All patients except the one with device expulsion responded to the conservative treatment after 1 year., Conclusion: The findings of the current study support LNG-IUS being effective for the treatment of PCDS-related intermenstrual bleeding. The authors recommend LNG-IUS as a treatment option for PCDS-related intermenstrual bleeding., (© 2019 Japan Society of Obstetrics and Gynecology.)

Objective: The aim of the present study was to describe various hysteroscopic findings of previous cesarean delivery scar defects (PCDS), and evaluate the relationship between these findings and abnormal uterine bleeding., Materials and Methods: This was a retrospective study including patients with abnormal uterine bleeding after a cesarean section. Transvaginal ultrasound and hysteroscopy were used to detect the origin of the symptoms, and the gynecological symptoms and hysteroscopic findings were recorded. Relationships between the hysteroscopic findings and abnormal uterine bleeding were evaluated., Results: Ninety-six (82.8%) patients presented with intermenstrual bleeding. The most common findings of scar defects on hysteroscopy were increased local vascularization (74.1%) and oozing spots (47.4%). Increased local vascularization on the defect was significantly related to intermenstrual bleeding (p = 0.048)., Conclusion: This study categorized different findings of PCDS under hysteroscopy. Increased local vascularization on the scar defect was significantly related to intermenstrual bleeding., (Copyright © 2019. Published by Elsevier B.V.)

Aim: To compare and evaluate the efficacy of the levonorgestrel‐releasing intrauterine system (LNG‐IUD) and resectoscopy remodeling procedure for intermenstrual bleeding associated with previous cesarean delivery scar defect (PCDS). Methods: A retrospective comparative study was conducted on patients with PCDS receiving LNG‐IUD (levonorgestrel 20 μg/24 h, N = 33) or resectoscopy remodeling (N = 27). Treatment outcomes were compared over 1, 6, and 12 months. Outcomes in patients with a retroverted or large uterus size, defect size, and local vascularization also were evaluated. Results: At 12 months post‐treatment, there were no significant differences between groups in efficacy rate; however, the reduction of intermenstrual bleeding days was higher in the LNG‐IUD group than in the resectoscopy group (13.6 vs. 8.5 days, p = 0.015). Within the first year, both groups experienced a reduction in bleeding days, but the decrease was greater in the LNG‐IUD group. Individuals exhibiting increased local vascularization at the defect site experienced more favorable outcomes in the LNG‐IUD group than the resectoscopy group (p = 0.016), and who responded poorly tended to have a significantly larger uterus in the LNG‐IUD group (p = 0.019). No significant differences were observed in treatment outcomes for patients with a retroverted uterus or large defect in either group. Conclusions: Our findings support that the LNG‐IUD is as effective as resectoscopy in reducing intermenstrual bleeding days associated with PCDS and can be safely applied to patients without recent fertility aspirations. Patients with increased local vascularization observed during hysteroscopy may benefit more from LNG‐IUD intervention than resectoscopy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of levonorgestrel 52 mg intrauterine system for intermenstrual bleeding in patients with previous cesarean delivery scar defects (PCDSs). Methods: The medical records of 28 consecutive patients with previous cesarean delivery scar defect and intermenstrual bleeding who had undergone conservative treatment with levonorgestrel 52 mg intrauterine system were reviewed. The efficacy of treatment and frequency of adverse events were measured retrospectively. Results: After 1 year of treatment, 22 patients (78.6%) reported an improvement in symptoms. The mean duration of menstruation were 18 and 5 days before and after treatment, respectively. No uterine perforations or pelvic inflammatory diseases occurred during or after the insertion procedures. Eighteen (64.3%) patients did not experience any adverse events, and the patients with adverse events reported that they could be managed by adjusting their medications or observation. Conclusion: Levonorgestrel intrauterine system may have a role in the safe and effective management of intermenstrual spotting in patients with PCDSs. [ABSTRACT FROM AUTHOR]