Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis

Abstract

Both, the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis, although no differences were observed between the two treatments. Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years. This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive.

Gynecologic Pain in Adolescents

“…The LNG-IUD has the advantages of avoiding compliance with a daily medication and offering highly efficacious long-acting reversible contraception. Studies have randomized women with known endometriosis to LNG-IUD or gonadotropin-releasing hormone agonists, and both treatments were found to be effective for pain control [13,14], while the LNG-IUD had higher continuation rates and lower pain scores at 3 years [15]. Future research evaluating the efficacy of LNG-IUD for adolescents with gynecologic pain is needed.…”

Laparoscopic Excision of Endometrioma

“…12 In a trial of 82 women with endometriosis the levonorgestrel intrauterine system had similar effectiveness to GnRH analogues, but the potential for long-term use of this system is advantageous if the woman does not want to conceive. 13 It has also been used in women with rectovaginal disease. 14 In the future aromatase inhibitors may have a therapeutic role in endometriosis as they inhibit estrogen production selectively in endometriotic lesions, without affecting ovarian function.…”

Tratamento da endometriose

“…Vercellini 45 foram os primeiros a testar o SIU-LNG na endometriose, mostrando sua boa efetividade no controle da dor. Em outro estudo prospectivo, randomizado e controlado, demonstrou-se diminuição importante, já no primeiro mês de uso, da dor pélvi-ca crônica secundária à endometriose 46 . Associada a melhora clínica, observou-se também a diminuição nos valores séricos de CA-125, marcador tumoral utilizado na prática clínica para acompanhamento da endometriose 47 .…”

“…Desde então, vários estudos foram realizados, comparando esta classe de drogas com os tratamentos para endometriose já existentes. Houve excelente resposta terapêutica, com melhora signifi cativa na dor pélvica associada a endometriose, e maior tempo para retorno dos sintomas e aparecimento de lesões císticas ovarianas (endometriomas) 46,[57][58][59] . A média de tempo para recidiva dos sintomas de dismenorréia, dispareunia e dor pélvica acíclica é muito variável: entre 6 e 12 meses após o fi nal do tratamento, Tratamento da endometriose porém geralmente a dor é de menor intensidade 60,61 .…”