title: Postoperative levonorgestrel-releasing intrauterine system versus oral contraceptives after gonadotropin-releasing hormone agonist treatment for preventing endometrioma recurrence.
abstract: OBJECTIVE
  Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is effective in reducing the recurrence of endometriosis-associated pain, its efficacy in preventing endometrioma recurrence is questionable. We compared the efficacy of postoperative use of LNG-IUS with oral contraceptives (OC) for preventing endometrioma recurrence.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Medical university hospital.
  
  
  METHODS
  Ninety-nine women with endometriomas.
  
  
  METHODS
  A chart review was performed of women of reproductive age who had undergone laparoscopic surgery for endometrioma followed by three cycles of gonadotropin-releasing hormone agonist (leuprolide acetate) treatment. Women were categorized into two groups: a group that had postoperative LNG-IUS placement (n = 42) and a group that received postoperative, cyclic, low-dose, monophasic, OCs (n = 57). Main outcome measures. Endometrioma recurrence was analyzed according to several clinical variables and postoperative treatment modalities.
  
  
  RESULTS
  During the follow-up period (median 17 months), recurrent endometriomas were detected in eight women (8.1%). Patients with LNG-IUS had a recurrence rate of 4.8% (2/42), whereas women receiving OC had a recurrence rate of 10.5% (6/57). Cumulative recurrence-free survival assessment revealed that mean disease-free survival times for both groups were similar, but that for LNG-IUS was slightly longer than that for OC, with statistical significance (34.4 ± 1.0 months, 95% confidence interval 32.3–36.5, vs. 33.4 ± 1.3 months, 95% confidence interval 30.8–36.0, p = 0.045). Univariate analysis revealed a hazard ratio of 0.178 (95% confidence interval 0.029–1.075) (p = 0.060) for postoperative LNG-IUS use and endometrioma recurrence. However, for the multivariate regression analysis, only postoperative serum CA 125 levels were significantly associated with endometrioma recurrence (hazard ratio 1.012, p = 0.010).
  
  
  CONCLUSIONS
  Postoperative LNG-IUS use seemed to be comparable to the use of cyclic OC in preventing endometrioma recurrence.
authors.forename: Sihyun
authors.initials: S
authors.lastname: Cho
authors.forename: Ji Ann
authors.initials: JA
authors.lastname: Jung
authors.forename: Yousun
authors.initials: Y
authors.lastname: Lee
authors.forename: Hye Yeon
authors.initials: HY
authors.lastname: Kim
authors.forename: Seok Kyo
authors.initials: SK
authors.lastname: Seo
authors.forename: Young Sik
authors.initials: YS
authors.lastname: Choi
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Byung Seok
authors.initials: BS
authors.lastname: Lee
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004715:Endometriosis / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016729:Leuprolide / Q000627:therapeutic use*; D016912:Levonorgestrel / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention
chemical_list: D003278:Contraceptives, Oral, Hormonal; D007987:Gonadotropin-Releasing Hormone; D016912:Levonorgestrel; D016729:Leuprolide