Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue.
OBJECTIVE
To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months.


METHODS
Prospective, randomized, controlled study.


METHODS
The reproductive endocrinology unit of a tertiary, research and education hospital.


METHODS
Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study.


METHODS
The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks.


METHODS
Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP).


RESULTS
The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction.


CONCLUSIONS
Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.
Bayoglu Tekin
Yesim
Y
Department of Obstetric and Gynecology, Agri Patnos Public Hospital, Ministry of Health, Patnos-Agri, Turkey.
Dilbaz
Berna
B
Altinbas
Sadiman Kiykac
SK
Dilbaz
Serdar
S
D000328:Adult; D002908:Chronic Disease; D003692:Delayed-Action Preparations; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D017273:Goserelin / Q000008:administration & dosage*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000188:drug therapy / Q000601:surgery*
D003692:Delayed-Action Preparations; D005300:Fertility Agents, Female; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D016912:Levonorgestrel