title: Uterine ultrasonographic changes during endometriosis treatment: a comparison between levonorgestrel-releasing intrauterine devices and a gonadotropin-releasing hormone agonist.
abstract: We compared the effects of levonorgestrel-releasing intrauterine devices (LNG-IUD) and a gonadotropin-releasing hormone agonist (GnRHa) on uterine volume, uterine arteries pulsatility index (PI) and endometrial thickness before and after six months of endometriosis treatment. Sixty women aged 18-40 y were allocated randomly to one of two groups: LNG-IUDs were inserted in 30 women, and GnRHa monthly injections were performed on the other 30. All 60 women were submitted to transvaginal 2-D ultrasound scans on the day that the treatment started and then six months later. Measurements of uterine arteries PI, uterine volume and endometrial thickness were performed at both evaluations. The use of LNG-IUDs significantly decreased endometrial thickness (pre = 6.08 +/- 3.00 mm, post = 2.7 +/- 0.98 mm; mean +/- SD), as did the use of GnRHa (pre = 6.96 +/- 3.82 mm, post = 3.23 +/- 2.32 mm). The uterine volume decreased in the GnRHa group (pre = 86.67 +/- 28.38 cm(3), post = 55.27 +/- 25.52 cm(3)), but not in the LNG-IUD group (pre = 75.77 +/- 20.88 cm(3), post = 75.97 +/- 26.62 cm(3)). Uterine arteries PI increased for both groups; however, the increase was higher in the GnRHa group (0.99 +/- 0.84 vs. 0.38 +/- 0.84, p = 0.007; PI increase in GnRHa and in LNG-IUD groups, respectively). In conclusion, levonorgestrel released directly onto the endometrium by the LNG-IUD induced smaller uterine changes than did the hypoestrogenism induced by GnRHa. Nevertheless, both promoted similar effects on endometrial thickness.
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine-Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Manetta
authors.forename: Wellington
authors.initials: W
authors.lastname: de Paula Martins
authors.forename: Júlio César
authors.initials: JC
authors.lastname: Rosa e Silva
authors.forename: Ana Carolina Japur
authors.initials: AC
authors.lastname: de Sá Rosa e Silva
authors.forename: Antônio Alberto
authors.initials: AA
authors.lastname: Nogueira
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
mesh_terms: D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016729:Leuprolide / Q000008:administration & dosage / Q000627:therapeutic use*; D016912:Levonorgestrel / Q000008:administration & dosage / Q000627:therapeutic use*; D011673:Pulsatile Flow / Q000187:drug effects; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D055815:Young Adult
chemical_list: D007987:Gonadotropin-Releasing Hormone; D016912:Levonorgestrel; D016729:Leuprolide