First of all, let’s understand the mechanism of action of Mannorrhea, it is a ring containing levonorgestrel, which is a highly effective progestin. It can also act locally in the uterine cavity to treat adenomyosis, excessive menstruation, anovulatory abnormal uterine bleeding and protect the endometrium. Of the progestins used clinically, only Mannoport is placed in the uterine cavity, while the others are taken orally. Oral progestins are metabolized by the liver and have hepatic first-pass effect, with low bioavailability and more side effects, but the Mannorrhea ring acts directly on the endometrium, with uterine first-pass effect, without hepatic first-pass effect. The purpose of using progestin is to act locally on the endometrium to counteract the proliferative effect of estrogen on the endometrium, and the characteristic of Mannorrhea is that it acts directly on the endometrium locally, and the effective therapeutic effect can be achieved at a very low dose without affecting ovulation. In addition, the compliance with the use of the Mannorrhoea ring is good, while the compliance with the oral progestogen is poor. The progesterone is released at 20ug per day at the beginning of the treatment and 10ug per day after 5 years, which is generally effective for 5 years. However, according to clinical research, when Mannorrhea is used to treat adenomyosis, it is effective within 3 years, but after 3 years, the adenomyosis may grow, so some experts suggest that it is better to change Mannorrhea once every 3 years when treating adenomyosis. However, the use for anovulatory abnormal uterine bleeding or excessive menstruation is still 5 years. Mannorrhea is not absorbed into the bloodstream and does not usually suppress the gonadal axis and affect ovulation. According to the data, if you want to suppress the gonadal axis, you need to release 50 ug per day, but Mannorrhea releases 20 ug per day, which usually does not affect ovulation. The release of 20ug per day in the uterine cavity will only affect 0.2% of the milk, so such a small dose will not affect breastfeeding and is relatively safe. Levonorgestrel has a long-term effect on the endometrium, causing atrophy of the glands, interstitial metaplasia and thinning of the endometrium, so it can treat excessive menstruation and protect the endometrium to prevent cancer. Because of its first-pass effect on the uterus, the treatment of adenomyosis can shrink adenomyoma and shrink the uterus significantly; it can also reduce the occurrence of dysmenorrhea, which is caused by excessive prostaglandin release from the endometrium, resulting in excessive contraction of the uterus. The use of Mannorrhea can cause the gland to shrink and the endometrium to become thinner, producing less prostaglandins, while the progestin (levonorgestrel) can inhibit the contraction of the uterus, achieving the effect of treating dysmenorrhea. If the uterus is less than 8 weeks of pregnancy, it can be placed directly; if the uterus is greater than 8 weeks of pregnancy, it is recommended to take GnRHa first and wait for the uterus to shrink before placing it, because even if the Manuel is displaced, as long as it is still in the uterine cavity, it will still release levonorgestrel to act on the endometrium and still have therapeutic effects. Generally speaking, irregular bleeding in the first six months of Mannorrhea use is due to levonorgestrel acting locally on the endometrium, causing glandular atrophy, interstitial metaplasia, improper estrogen-progestin ratio, and estrogen cannot maintain the integrity of the endometrium, resulting in progestin breakthrough bleeding, so if vaginal drenching bleeding occurs in the first six months, it can be observed. If the patient asks for treatment, you can use compounded short-acting oral contraceptives or Mangalax 2mg can be used, and the symptoms will usually disappear after six months of IUD use. The incidence of menorrhagia is 17% after 1 year of use and 27% after 5 years of use. In the treatment of excessive menstruation, the menstrual flow is reduced by 86% after 3 months of use and 97% after 1 year of use.