Effects of Etonogestrel implants on pelvic pain and menstrual flow in women suffering from adenomyosis or endometriosis

Abstract

Adenomyosis and endometriosis are common causes of pelvic pain in women of reproductive age. Furthermore, adenomyosis is a major cause of menorrhagia. This study aimed to evaluate the effects of Etonogestrel implants on pelvic pain and menstrual flow in women requiring long-acting reversible contraception and suffering from adenomyosis or endometriosis. One hundred women with adenomyosis or endometriosis and asking for contraception with Etonogestrel implants were enrolled in this study and were followed-up for 24 months. Patients were interviewed on pelvic pain by visual analog scale (VAS) pain score, menstrual flow by the number of sanitary napkins, menstrual bleeding pattern, weight gain, breast pain, and any other treatment side effects. Seventy four patients who were treated with Etonogestrel implants completed the 24-month follow-up in which we found a significant decrease in pelvic pain VAS scores comparing baseline scores to 6, 12, and 24 months (baseline: 6.39 ± 2.35 to 24-month: 0.17 ± 0.69, P < 0.05). The menstrual volume decreased significantly compared with that at baseline ((40.69 ± 30.92) %, P < 0.05). However, vaginal bleeding, amenorrhea, weight gain, and acne occurred after treatment in some patients. Etonogestrel implants were effective in reducing pelvic pain and menstrual flow of adenomyosis or endometriosis.

Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach

“…Similar results have been obtained with subcutaneous progestin (etonogestrel), particularly a clear reduction in pain symptoms, but vaginal bleeding caused several patients to have their implants removed [ 22 , 23 , 24 ]. Decreased uterine volume, an important parameter linked to menorrhagia, may or may not be achieved in adenomyosis patients treated with etonogestrel, depending on the study [ 23 , 24 ].…”

Safety and Benefits of Contraceptives Implants: A Systematic Review

“…The ENG-releasing subdermal implant could be employed immediately after a surgical abortion [190][191][192] or on the same day of mifepristone assumption, without an increase in pregnancy risk compared to the delayed placement 4-8 weeks after the procedure [195][196][197]199]. It has been shown to be effective in improving symptomatic endometriosis with reduction in pain severity and menstrual symptoms (dysmenorrhea and dyspareunia) [201,210,211]; ENG therapeutic efficacy for pain relief is not inferior to other progestins [209,210].…”

“…In 2005, a case series study showed that ENG subdermal implants could represent a treatment option in women with severe symptoms related to pelvic endometriosis [208]. More recently, Niu et al [211] confirmed that compared to the baseline, at the 24-month follow-up, ENG users had a significant (p < 0.05) decrease in pelvic pain and menstrual volume (p < 0.05) [211].…”

Sex hormone-related polymorphisms in endometriosis and migraine: A narrative review

“… 139 Whereas treatment with progestin-only has a positive impact on both conditions. 30 , 140 – 143 Therefore, patients with the comorbidity of migraine and endometriosis would profit if their attending physician could identify the co-occurrence to optimize hormonal treatment.…”