Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial.
BACKGROUND
Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long-term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel-releasing intrauterine system (LNG-IUS) may be a useful form of prolonged progestogen therapy for endometriosis.


OBJECTIVE
To evaluate and compare the efficacy and safety of LNG-IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients' acceptance.


METHODS
A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG-IUS and 15 had three-monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student's t-test and chi-square test.


RESULTS
Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG-IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG-IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm(2)) than Depot MPA users (-0.030, -0.017 g/cm(2)) in both hip and lumbar regions.


CONCLUSIONS
Levonorgestrel-releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG-IUS users showed a better compliance. After three years, bone gain was noted with LNG-IUS, but bone loss with depot MPA.
Wong
Alice Yuen Kwan
AY
Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong, China. alicewyk@netvigator.com
Tang
Lawrence Chang Hung
LC
Chin
Robert Kien Howe
RK
D000328:Adult; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000627:therapeutic use*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate