Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study.
OBJECTIVE
To determine whether the frequency and severity of dysmenorrhea are reduced in women with symptomatic endometriosis in whom a levonorgestrel-releasing intrauterine device (Lng-IUD) is inserted after operative laparoscopy compared with those treated with surgery only.


METHODS
Open-label, parallel-group, randomized, controlled trial.


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


METHODS
Parous women with moderate or severe dysmenorrhea undergoing first-line operative laparoscopy for symptomatic endometriosis.


METHODS
Randomization to immediate Lng-IUD insertion or expectant management after laparoscopic treatment of endometriotic lesions. Proportions of women with recurrence of moderate or severe dysmenorrhea in the two study groups 1 year after surgery and overall degree of satisfaction with treatment. Moderate or severe dysmenorrhea recurred in 2 of 20 (10%) subjects in the postoperative Lng-IUD group and 9/20 (45%) in the surgery-only group. Thus, a medicated device inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients 1 year after surgery. A total of 15/20 (75%) women in the Lng-IUD group and 10/20 (50%) in the expectant management group were satisfied or very satisfied with the treatment received.


CONCLUSIONS
Insertion of an Lng-IUD after laparoscopic surgery for symptomatic endometriosis significantly reduced the medium-term risk of recurrence of moderate or severe dysmenorrhea.
Vercellini
Paolo
P
Clinica Ostetrica e Ginecologica I, Istituto "Luigi Mangiagalli", University of Milano, Milan, Italy. paola.vercellini@unimi.it
Frontino
Giada
G
De Giorgi
Olga
O
Aimi
Giorgio
G
Zaina
Barbara
B
Crosignani
Pier Giorgio
PG
D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology / Q000517:prevention & control*; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011182:Postoperative Care; D045167:Progesterone Congeners / Q000008:administration & dosage*; D055502:Secondary Prevention
D045167:Progesterone Congeners; D016912:Levonorgestrel