The evaluation of the effectiveness of an intrauterine‐administered progestogen (levonorgestrel) in the symptomatic treatment of endometriosis and in the staging of the disease

• Published in: Human reproduction (Oxford) Vol. 19; no. 1; pp. 179 - 184
• Main Authors: Lockhat, F.B., Emembolu, J.O., Konje, J.C.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2004; Oxford Publishing Limited (England)
• Subjects: Adult; Biological and medical sciences; Cohort Studies; Embryology: invertebrates and vertebrates. Teratology; Endometriosis; Endometriosis - drug therapy; Endometriosis - pathology; Endometriosis - physiopathology; endometriosis/levonorgestrel‐releasing intrauterine system/mirena; Female; Fundamental and applied biological sciences. Psychology; Humans; Intrauterine Devices, Medicated; Levonorgestrel - administration & dosage; Levonorgestrel - adverse effects; Menstruation Disturbances - physiopathology; Palliative Care; Progestins - administration & dosage; Progestins - adverse effects; Severity of Illness Index; Treatment Outcome; endometriosis/levonorgestrel‐releasing intrauterine system/mirena; Vertebrata; Mammalia; Treatment; endometriosis/levonorgestrel-releasing intrauterine system/mirena; Levonorgestrel; Uterine diseases; Endometriosis; Contraceptive; Female genital diseases; Progestagen
• ISSN: 0268-1161; 1460-2350; 1460-2350
• DOI: 10.1093/humrep/deh004

BACKGROUND: Medical treatment of endometriosis, a condition which significantly affects the quality of life in ∼10–15% of women in the reproductive years, remains problematic. Although oral progestogens are effective and cheap, their efficacy is significantly influenced by poor compliance and systemic side effects. A progestogen (levonorgestrel) administered via an intrauterine system (Lng‐IUS) has been demonstrated to improve symptoms of endometriosis; however, its effect on the staging of the disease has not been evaluated. The aims of this study were therefore to investigate the effectiveness of Lng‐IUS in the symptomatic relief of minimal to moderate endometriosis and in the staging of the disease. METHODS: This was a prospective non‐comparative observational study in which 34 women with clinically suspected and laparoscopically confirmed symptomatic minimal to moderate endometriosis had Lng‐IUS inserted for 6 months. The symptom profile and stage of the disease before, during and after 6 months of treatment and patients’ satisfaction with treatment and willingness to retain the device at the end of the study period were used to assess response to treatment. RESULTS: Of the 34 women recruited, 29 (85%) completed the study; five discontinued, for personal reasons (one), side effects of worsening of acne (one) and lower abdominal/ pelvic pain (three). Significant (P < 0.05) improvements in severity and frequency of pain and menstrual symptoms as well as staging were achieved, with 68% (23) of cases electing to continue with the device after 6 months of therapy. CONCLUSION: The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long‐term therapy in a substantial number of sufferers, although this would require further study and verification.