[Effects of levonorgestrel-releasing intrauterine system on pain and recurrence associated with endometriosis and adenomyosis].
OBJECTIVE
To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of pain associated with endometriosis (EM) and adenomyosis (AM), and in prevention of disease recurrence.


METHODS
Thirty-three cases of moderate to severe EM or AM patients received insertion of LNG-IUS immediately after conservative operation, or after recurrence of simple pain, and were self controlled respectively before and after insertion of LNG-IUS. The visual analogue scale (VAS) was compared, and the change of the lesion and the uterine size, as well as the serum steroid and CA(125) were observed. The side-effects, such as bleeding pattern were recorded. The bleeding period was compared between the cases injected with or without gonadotropin-releasing hormone agonist (GnRHa) before insertion of LNG-IUS.


RESULTS
Baseline and follow-up VASs of EM were 8.09 +/- 0.21 and 1.64 +/- 1.12 (P = 0.042), of AM were 8.41 +/- 1.59 and 3.99 +/- 3.87 (P = 0.068), respectively. During nearly 2 years' follow-up, moderate dysmenorrhea recurred in only 1 case who was hyper-estrogenism at that time. Generally, irregular bleeding and spotting period were longer in this LNG-IUS treated group than those reported in literatures in which LNG-IUS was used for contraception. Persistent prolonged spotting was seen in most of the patients during 1 year follow-up. Average bleeding days in one month during the first 6 months after insertion of LNG-IUS were both around 18 days, whether using GnRHa or not.


CONCLUSIONS
LNG-IUS greatly reduces pain associated with EM and AM, and delays disease recurrence. Irregular bleeding and spotting is the main side effects. Administration of GnRHa in advance does not improve the bleeding symptoms.
Deng
Shan
S
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Lang
Jing-he
JH
Leng
Jin-hua
JH
Liu
Zhu-feng
ZF
Sun
Da-wei
DW
Zhu
Lan
L
D000328:Adult; D003692:Delayed-Action Preparations; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008598:Menstruation / Q000187:drug effects; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology; D055502:Secondary Prevention; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000188:drug therapy*
D003692:Delayed-Action Preparations; D016912:Levonorgestrel