Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery

Abou-Setta, AM; Al-Inany, HG; Farquhar, Cindy

doi:10.1002/14651858.cd005072

Cited by 15 publications

(15 citation statements)

References 24 publications

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“…Systematic reviews of the literature have suggested that progestins and the levonorgestrel releasing intrauterine device significantly reduce pain symptoms compared with placebo. 14,15 Caution must be taken when administering continuous progestins systemically, as prolonged use has been shown to decrease bone mineral density. In 2004, practitioners were cautioned against the use of depot medroxyprogesterone acetate for longer than 2 years, as it is unknown whether prolonged use during adolescence ultimately leads to more bone loss and osteoporotic fractures.…”

Section: Chronic Pelvic Pain and Endometriosismentioning

confidence: 99%

Pediatric and Adolescent Gynecologic Laparoscopy

Broach¹,

Mansuria²,

Sanfilippo

2009

Clinical Obstetrics &Amp; Gynecology

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Minimally invasive techniques to treat children and adolescents requiring surgery have increasingly become standard of care. Similarly, gynecologists frequently use laparoscopy to treat pelvic pathology. We present the necessary equipment and surgical techniques required to perform gynecologic procedures on the pediatric and adolescent population. We will give particular focus to the treatment of adnexal masses, chronic pelvic pain, endometriosis, and ovarian torsion. We will also discuss the role of the incidental appendectomy in children and adolescents.

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Section: Chronic Pelvic Pain and Endometriosismentioning

confidence: 99%

Pediatric and Adolescent Gynecologic Laparoscopy

Broach¹,

Mansuria²,

Sanfilippo

2009

Clinical Obstetrics &Amp; Gynecology

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“…4 Second-line medical therapy usually consists of continuous progestogen provision either as the levonorgestrel intra-uterine system (LNG-IUS (Mirena Õ )), continuous oral norethisterone (NET), an etonogestrel implant or depot injections of medroxyprogesterone acetate (MPA). 5 If these are ineffective, treatment may progress to complete suppression of the hypothalamic-pituitary-ovary (HPO) axis with a GnRH agonist. 6 The ESHRE guidelines recommend the use of 'hormonal contraceptives, progestogens, anti-progestogens or GnRH agonists' as they reduce endometriosis pain.…”

Section: Endometriosismentioning

confidence: 99%

Minimising menopausal side effects whilst treating endometriosis and fibroids

et al. 2015

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Medical management of endometriosis and fibroids involves manipulation of the hypothalamic-pituitary-gonadal axis to alter the balance of sex hormones thereby inhibiting disease progression and ameliorate symptoms. Unfortunately, resultant menopausal symptoms sometimes limit the tolerability and duration of such treatment. The use of gonadotrophin-releasing hormone agonists to treat these diseases can result in short-term hypoestrogenic and vasomotor side effects as well as long-term impacts on bone health and cardiovascular risk. The routine use of add-back hormone replacement has reduced these risks and increased patient compliance, making this group of drugs more useful as a medium-term treatment option. The estrogen threshold hypothesis highlights the concept of a 'therapeutic window' in which bone loss is minimal but the primary disease is not aggravated. It explains why add-back therapy is appropriate for such patients and helps to explain the basis behind new developments in the treatment of hormonally responsive gynaecological conditions such as gonadotrophin-releasing hormone antagonists and progesterone receptor modulators.

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“…Existing data show no benefit of presurgical medical suppressive therapy for endometriosis, 31 although postoperative cyclic OCP and levonorgestrel-secreting IUDs have been demonstrated to reduce dysmenorrhea after endometriosis surgery. 32,33 After endometrioma ovarian cystectomy, both cyclic (14.7%) and continuous (8.2%) OCPs reduced the risk of endometrioma recurrence compared with no treatment (29%). 34 In a study of patients with endometriosis and definitive hysterectomy endometriosis-related symptoms, ovarian preservation was associated with a significantly greater risk of subsequent symptoms and further surgery.…”

Section: Surgical Therapy For Endometriosismentioning

confidence: 99%