Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue.

Abstract

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.

DESIGN:

Prospective, randomized, controlled study.

SETTING:

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

PATIENT(S):

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.

INTERVENTION(S):

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.

MAIN OUTCOME MEASURE(S):

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

RESULT(S):

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.

CONCLUSION(S):

Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.

• Authors: Yesim Bayoglu Tekin, Berna Dilbaz, Sadiman Kiykac Altinbas, Serdar Dilbaz
• Journal: Fertility and sterility (Fertil Steril) Vol. 95 Issue 2 Pg. 492-6 (Feb 2011) ISSN: 1556-5653 [Electronic] United States
• PMID: 20883991 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Delayed-Action Preparations
• Fertility Agents, Female
• Goserelin
• Gonadotropin-Releasing Hormone
• Levonorgestrel

Topics

• Adult
• Chronic Disease
• Delayed-Action Preparations
• Endometriosis (complications, drug therapy, surgery)
• Female
• Fertility Agents, Female (administration & dosage)
• Follow-Up Studies
• Gonadotropin-Releasing Hormone (administration & dosage, adverse effects, analogs & derivatives)
• Goserelin (administration & dosage)
• Gynecologic Surgical Procedures (adverse effects, rehabilitation)
• Humans
• Intrauterine Devices, Medicated (adverse effects)
• Levonorgestrel (administration & dosage, adverse effects)
• Pain, Postoperative (drug therapy)
• Pelvic Pain (drug therapy, etiology)
• Treatment Outcome
• Uterine Diseases (complications, drug therapy, surgery)