Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial

Abstract

Objective: To assess the efficacy of an etonogestrel (ENG)-releasing contraceptive implant or the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) in the control of endometriosis-associated pelvic pain. Design: Noninferiority randomized clinical trial in which women with endometriosis were assigned to use an ENG implant (experimental treatment) or an LNG-IUS (active comparator). Monthly follow-up visits were conducted up to 6 months. Setting: University teaching hospital. Patient(s): One hundred three women, with endometriosis-associated chronic pelvic pain, dysmenorrhea, or both for more than 6 months. In cases of deep endometriosis, vaginal ultrasonography and magnetic resonance imaging were used as additional diagnostic tools. Intervention(s): The ENG implant or the LNG-IUS were inserted within the first 5 days of the menstrual cycle. Main Outcome Measure(s): Daily scores of noncyclic pelvic pain and dysmenorrhea were evaluated using a daily visual analogue scale. Health-related quality of life was evaluated using the Endometriosis Health Profile-30 questionnaire at baseline and up to 6 months. Bleeding patterns were assessed daily from a menstrual calendar. Result(s): Both contraceptives improved significantly the mean visual analogue scale endometriosis-associated pelvic pain and dysmenorrhea, without significant differences between treatment group profiles. Health-related quality of life improved significantly in all domains of the core and modular segments of the Endometriosis Health Profile-30 questionnaire, with no difference between both treatment groups. The most common bleeding patterns at 180 days of follow-up were amenorrhea and infrequent bleeding and infrequent bleeding and spotting among ENG implant and LNG-IUS users, respectively. Conclusion(s): In this noninferiority study both contraceptives improved significantly pelvic pain, dysmenorrhea, and health-related quality of life in endometriosis.

Best Practices for Counseling Adolescents about the Etonogestrel Implant

“…45 ENG implant also reduces non cyclic chronic pelvic pain and dysmenorrhea associated with endometriosis-associated pelvic pain. 46,47 As the ENG implant suppresses ovulation, it likely has the ability to help in any cycle-related disorders.…”

FSRH Guideline (February 2021) Progestogen-only Implant

“…There was a slightly smaller reduction in pain scores in the DMPA group. Similarly, a study in Brazil that randomised 103 women with endometriosis-associated pelvic pain, dysmenorrhoea or both to use of an ENG-IMP or a 52 mg LNG-IUS reported significantly reduced visual analogue scores in both groups for pelvic pain and dysmenorrhoea over 6 months of use 61…”

Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial

“…(105). In addition to its high effectiveness and high continuation rate, the implant is effective in reducing dysmenorrhea caused by endometriosis (141). Based on these findings, it becomes clear that the implant is a neglected option for many women and should be promoted to a greater extent.…”