A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study.
OBJECTIVE
To evaluate the efficacy and safety of an intrauterine system releasing 20 microg of levonorgestrel per 24 hours in the long-term treatment of recurrent dysmenorrhea in women already operated on conservatively for endometriosis.


METHODS
A prospective noncomparative pilot study.


METHODS
A tertiary care and referral academic center for patients with endometriosis.


METHODS
Twenty parous women with recurrent moderate or severe dysmenorrhea after conservative surgery for endometriosis who did not want further children.


METHODS
A levonorgestrel-releasing intrauterine system was inserted in each woman within 7 days of the start of a menstrual cycle.


METHODS
Variations in severity of dysmenorrhea during treatment according to a 100-mm visual analogue scale and a 0-3-point verbal rating scale, modification of a pictorial blood-loss assessment chart devised to evaluate the amount of menstrual flow, and degree of satisfaction after 12 months of therapy.


RESULTS
One woman was lost to follow-up after achieving amenorrhea and expressing satisfaction, and 1 requested system removal because of weight gain and abdominal bloating. In another subject, the levonorgestrel intrauterine system was expelled 3 months after insertion. The menstrual patterns in the remaining 17 women were characterized by amenorrhea in 4 cases, hypomenorrhea or spotting in 8, and normal flow in 5. Baseline and 12-month follow-up mean +/- SD blood loss scores were 111+/-36 and 27+/-26, respectively. At the same time, mean +/- SD visual analogue and verbal rating scale scores dropped, respectively, from 76+/-12 to 34+/-23 points and from 2.5+/-0.5 to 1.2+/-0.5 points. Four women were very satisfied with treatment, 11 were satisfied, 2 were uncertain, and 3 were dissatisfied at 12-month follow-up.


CONCLUSIONS
Because of the amenorrhea or hypomenorrhea induced in most women, a levonorgestrel intrauterine system greatly reduced menstrual pain associated with endometriosis and achieved a high degree of patient satisfaction.
Vercellini
P
P
Clinica Ostetrica e Ginecologica Luigi Mangiagalli, University of Milano, Italy. pgcros@imiucca.unimi.it
Aimi
G
G
Panazza
S
S
De Giorgi
O
O
Pesole
A
A
Crosignani
P G
PG
D000328:Adult; D004412:Dysmenorrhea / Q000188:drug therapy* / Q000209:etiology; D004715:Endometriosis / Q000150:complications*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008597:Menstrual Cycle; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D014599:Uterus / Q000187:drug effects
D016912:Levonorgestrel