Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial.
OBJECTIVE
To estimate the effectiveness of a postoperative levonorgestrel-releasing intrauterine system for relieving pelvic pain in patients with endometriosis.


METHODS
A double-blind randomized controlled trial was conducted in 55 patients with endometriosis and moderate-to-severe dysmenorrhea (visual analog scale, greater than 50 mm) undergoing laparoscopic conservative surgery. After surgery, patients were randomized to a levonorgestrel-releasing intrauterine system (n=28) or expectant management (n=27) group. Primary outcome was the change of dysmenorrhea visual analog scale. Secondary outcomes included changes of pelvic pain and dyspareunia visual analog scale, Short Form-36 score, and adverse effects.


RESULTS
The two groups were comparable in age, body mass index, parity, and baseline pain scores. At 12 months, the levonorgestrel-releasing intrauterine system group had a significantly lower median value of dysmenorrhea and noncyclic pelvic pain score. Compared with the control group, the levonorgestrel-releasing intrauterine system group had greater reduction in dysmenorrhea visual analog scale (-81.0 compared with -50.0 mm, P=.006) and pelvic pain visual analog scale (-48.5 compared with -22.0 mm, P=.038) but a comparable reduction in dyspareunia visual analog scale (-15.0 compared with -19.0 mm, P=.831). Two patients in levonorgestrel-releasing intrauterine system group (7.4%) and nine in the expectant management group (39.1%) had recurrent dysmenorrhea within 1 year postoperatively (P=.014). Number-needed-to-treat to prevent one case with recurrent dysmenorrhea within the first year was three cases. The Short Form-36 scores improved in the levonorgestrel-releasing intrauterine system group but did not change in the expectant management group. There was no serious adverse event during the study period.


CONCLUSIONS
The levonorgestrel-releasing intrauterine system is effective and well accepted for long-term therapy after conservative surgery for patients with moderate to severe pain related to endometriosis. It can improve the patient's quality of life, including physical and mental health.
Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sipta@mahidol.ac.th
Prasong
P
Tanmahasamut
Manee
M
Rattanachaiyanont
Surasak
S
Angsuwathana
Kitirat
K
Techatraisak
Suchada
S
Indhavivadhana
Pichai
P
Leerasiri
D000328:Adult; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D004311:Double-Blind Method; D004412:Dysmenorrhea / Q000188:drug therapy / Q000601:surgery; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D010535:Laparoscopy; D016912:Levonorgestrel / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000188:drug therapy* / Q000601:surgery; D011788:Quality of Life; D012720:Severity of Illness Index
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel