Amaç: İstmosel tanısı almış hastalarda intermenstrüel kanamanın tedavisinde kombine oral kontraseptifler (KOK) ile levonorgestrel salgılayan rahim içi aracın (LNG-RİA) etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamızda, 2018-2024 yılları arasında hastanemizde istmosel tanısı konulan ve intermenstrüel kanama nedeniyle KOK veya LNG-RİA tedavisi gören 104 hasta retrospektif olarak karşılaştırıldı. Tüm hastalar hasta dosyalarından dismenore, intermenstrüel kanama, dispareuni ve persistan pelvik ağrı semptomları öyküsü açısından araştırıldı. Bulgular: Ortalama yaş LNG-RİA grubunda KOK grubuna göre anlamlı yüksek saptandı (p=0.042). Vücut kitle indeksi değeri LNGRİA grubunda KOK grubuna göre anlamlı yüksekxsaptandı (p=0.044). Sigara içme oranı LNG-RİA grubunda KOK grubuna göre anlamlı yüksek saptandı (p<0.001). 12. ay takipte intermenstrüel kanama oranı LNG-RİA grubunda KOK grubuna göre anlamlı yüksek saptandı (p<0.001). 12. ay takipte adet uzunluğu LNG-RİA grubunda KOK grubuna göre anlamlı kısa saptandı (p=0.048). 12. ay takipte pelvik ağrı skoru LNG-RİA grubunda KOK grubuna göre anlamlı düşük saptandı (p=0.042). Sonuç: Bu çalışma, LNG-RİA ve KOK tedavisinin intermenstrüel kanama tedavisindeki etkinliğini karşılaştıran önemli veriler sunmaktadır. LNG-RİA, pelvik ağrıyı ve adet süresini azaltmada daha etkili görünse de, intermenstrüel kanama üzerindeki etkileri KOK tedavisinden daha sınırlıdır. Randomize kontrollü çalışmalar, tedaviye verilen farklı yanıtların mekanizmalarını araştırmaya odaklanmalıdır.

Objective: To compare the effectiveness of combined contraceptives (COC) and a levonorgestrell-releasiing-intrauteriine-device (LNG-IUD) in the treatment of intermenstrual bleeding in patients with isthmocele diagnoses. Material and Methods: 104 patients who were diagnosed with isthmocele in our hospital between 2018-2024 and received COC or LNG-IUD treatment due to intermenstrual bleeding were compared retrospectively. All patients were investigated for histories of symptoms of dysmenorrhea, intermenstrual bleeding, dyspareunia, and persistent pelvic pain from patient files. Results: The mean age was significantlly hiigher in the LNG-IUD group in comparison with the COC group (p=0.042). The BMI value was significantly higher in the LNG-IUD group compared wiith the COC-group (p=0.044). The rate of smoking was significantlly hiigher in the LNGIUD group than in the COC-group (p<0.001). The rate of intermenstrual bleeding in the 12th-month follow-up was significantly higher in the LNG-IUD group in comparison with the COC group (p<0.001). The menstrual length in the 12th-month follow-up was significantly lower in the LNG-IUD group compared with the COC group (p=0.048). The pelvic pain score in the 12th-month follow-up was significantlyxlower in the LNG-IUD group than in the COCxgroup (p=0.042). Conclusion: This study provides important data comparing the efficacy of LNG-IUD and COC therapy in the treatment of intermenstrual bleeding. Although LNG-IUD appears to be more effective in reducing pelvic pain and menstrual duration, its effects on intermenstrual bleeding are more limited than COC therapy. Randomized controlled trials should be focused on investigating the mechanisms of different responses to treatment.

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