Lng-IUD After Surgery for Symptomatic Endometriosis Reduces Recurrence of Dysmenorrhea

Mindy Hung

August 29, 2003

Aug. 29, 2003 — Insertion of a levonorgestrel-releasing intrauterine device (Lng-IUD) after laparoscopic surgery for symptomatic endometriosis reduces the medium-term risk of recurrence of moderate or severe dysmenorrhea, according to results of an open-label, randomized controlled pilot study published in the August issue of Fertility and Sterility.

"Laparoscopic surgery is often the treatment of choice for symptomatic disease, but results are not always satisfactory and pain recurrence is common," write Paolo Vercellini, MD, and colleagues, from the Istituto "Luigi Mangiagalli" at the University of Milano, Italy.

Investigators enrolled 40 of 77 parous women aged 40 years or younger who were undergoing first-line operative laparoscopy for symptomatic stage I-IV endometriosis, did not want children, and had reported disabling dysmenorrhea of more than six months' duration. Twenty subjects were allocated to Lng-IUD insertion after laparoscopic treatment, and 20 to conservative surgery only.

One year after surgery, patients were asked to complete questionnaires that graded presence and severity of dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain on a modified Biberoglu and Berhman rating scale, which reflected functional impairment, and on a 100-mm visual analog scale that estimated subjective perception of symptoms. The women also rated their overall degree of satisfaction with the treatment.

Moderate or severe dysmenorrhea recurred in 2 (10%) of 20 patients in the postoperative Lng-IUD group and in 9 (45%) of 20 in the surgery-only group. The absolute risk reduction of dysmenorrhea recurrence in subjects undergoing Lng-IUD insertion compared with those allocated to expectant management was 35% (95% confidence interval [CI], 9% - 61%).

"This means that an Lng-IUD inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients (95% CI, 2-11) 1 year after surgery, with a relative risk reduction of 78%," investigators write.

Fifteen (75%) of 20 patients in the Lng-IUD group and 10 (50%) of 20 patients in the expectant management group were satisfied or very satisfied with the treatment received.

"Insertion of a medicated device after conservative surgery for endometriosis may constitute an innovative, effective, safe, and convenient adjuvant treatment for the long-term reduction of risk of dysmenorrhea recurrence," they conclude. "Further trials are needed to verify whether the good results observed are maintained during the entire 5-year period of efficacy of the system."

Fertil Steril. 2003;80:305-309

Reviewed by Brunilda Nazario, MD

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