Postoperative Levonorgestrel-Releasing Intrauterine System Insertion After Gonadotropin-Releasing Hormone Agonist Treatment for Preventing Endometriotic Cyst Recurrence: A Prospective Observational Study

Abstract

The aim of this study was to evaluate the effectiveness of postoperative levonorgestrel-releasing intrauterine system (LNG-IUS) insertion after gonadotropin-releasing hormone agonist (GnRH-a) treatment for preventing endometriotic cyst recurrence. Study Design: The LNG-IUS was applied to 28 women who had undergone surgery for endometriosis followed by 6 cycles of GnRH-a treatment. Clinical characteristics, endometriosis recurrence, and adverse effects were analyzed. Student t test was performed for analysis. Results: Before surgery, 20 (71.4%) patients had dysmenorrhea, and the mean pain score (visual analog scale [VAS]) was 4.26. The numbers of women diagnosed with stage III endometriosis and stage IV endometriosis were 15 (53.6%) and 13 (46.4%), respectively, according to the revised American Fertility Society scoring system. The mean cancer antigen 125 levels and VAS scores were significantly lower after treatment than before treatment (11.61 vs 75.66 U/mL, P < .0001 and 0.50 vs 4.26 U/mL, P < .0001, respectively). Of the 28 patients, 13 (46.4%) simultaneously had adenomyosis, and 2 (7.1%) underwent LNG-IUS removal because of unresolved vaginal bleeding and dysmenorrhea. Recurrence was noted in 2 (7.1%) women. Conclusion:Postoperative LNG-IUS insertion after GnRH-a treatment is an effective approach for preventing endometriotic cyst recurrence, especially in women who do not desire to conceive.

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

“…There was a significant decrease in the recurrence rate of dysmenorrhea (P¼ .019) and significant reduction in the mean dysmenorrhea VAS score when compared with non-users. Additionally, a significant improvement in the VAS pain score (baseline 4.26 vs. 0.50, P< .0001) was reported among 28 patients after laparoscopic surgery for endometriosis followed up for 3 years after placement of the LNG-IUS (26). The bleeding patterns reported in our study for both contraceptive methods are those commonly associated with progestin-only contraceptive use.…”

“…Two studies have evaluated the long-term effectiveness of the LNG-IUS in patients with endometriosis-associated pelvic pain (25,26). Other authors (25) assessed the LNG-IUS for up to 30 months after insertion following surgical excision of endometriotic lesions and endometriomas.…”

Risk Factors for Recurrence of Ovarian Endometriosis in Chinese Patients Aged 45 and Over

“…There is no consensus regarding whether the levonorgestrel-releasing intrauterine device could reduce the recurrence rate either. [ 19 20 ] Our study showed that postoperative medication was not an independent risk factor for ovarian EM in patients aged 45 years and over, nor did it affect the recurrence in patients who underwent ovarian preservation surgery.…”

Anastrozole and Levonorgrestrel-Releasing Intrauterine Device in the Treatment of Endometriosis: A Randomized Clinical Trial.

“…Previously Vercellini et al [24] had published a pilot study using LNG-IUD versus expectant management after CS for symptomatic endometriosis with signi cant reduction of dysmenorrhea and risk of recurrence. Subsequently, other studies [9,[25][26][27][28][29][30][31][32] have also shown that LNG-IUD is an effective and well accepted treatment to reduce dyspareunia and dysmenorrhea and increase quality of life in women with suspected endometriosis. However, the long-term maintenance therapy using LNG-IUD after surgery was not effective for preventing endometrioma recurrence [30].…”