The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis.
Vercellini P, Obstetrics and Gynecology Clinic, Luigi Mangiagalli Institute, University of Milan, Milan, Italy. paolo.vercellini@unimi. It
The aim of this article is to evaluate the biological rationale for the use of an intrauterine device releasing 20 mug/day of levonorgestrel in women with endometriosis, and to assess its efficacy in relieving pelvic pain symptoms.
Levonorgestrel induces endometrial glandular atrophy and extensive decidual transformation of the stroma, downregulates endometrial cell proliferation, increases apoptotic activity, and has antiinflammatory and immunomodulatory effects. Up to 85% of patients wearing the device have anovulatory cycles during the first 3 months of use, but the proportion falls to below 35% by 12 months. After the first year of use, a 70-90% reduction in monthly blood loss is observed; few women report intermenstrual bleeding and about 20-30% amenorrhea. This is advantageous in patients experiencing dysmenorrhea. Although it is maintained that the hormonal activity of the levonorgestrel intrauterine device is local, a systemic effect secondary to uterine absorption of levonorgestrel is probable. The levonorgestrel intrauterine device has proven effective in relieving pelvic pain symptoms caused by peritoneal and rectovaginal endometriosis and in reducing the risk of recurrence of dysmenorrhea after conservative surgery. Intrauterine administration of levonorgestrel with direct distribution to pelvic tissues would imply a local concentration greater than plasma levels. This could result in a superior effectiveness with limited adverse effects and increased patient compliance during long-term treatment. Further trials are needed, however, to verify whether the good results observed are maintained during an entire 5-year period, to confirm the efficacy on dyspareunia and dyschezia, and to compare the effects of the levonorgestrel intrauterine device with those of other treatment options.Purpose of Review
Recent Findings
Summary
Please click on the required question.
- Pelvic Pain. Is this a common problem?
- What are the common causes of pelvic pain in women?
- What are the more common gynaecological causes of pelvic pain?
- What are the more common non-gynaecological causes of pelvic pain?
- What are primary and secondary dysmenorrhoea - painful periods?
- What is retrograde menstruation?
- How can dysmenorrhoea - painful periods be treated?
- What are ovarian cysts?
- How do ovarian cysts cause pain?
- How are ovarian cysts diagnosed?
- How are ovarian cysts treated?
- I think I may be pregnant and I have some pelvic pain. What should I do?
- What is pelvic inflammatory disease and how can it be treated?
- Mittelschmertz
- What are fibroids?
- I have fibroids. What difficulties might they cause for me?
- How are fibroids diagnosed?
- How could my fibroids be treated?
ENDOMETRIOSIS
- What is endometriosis?
- How prevalent is endometriosis?
- What causes endometriosis?
- How can my endometriosis be treated?
- How can my doctor determine the cause of my pelvic pain?
- What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- What is laparoscopy?
- What are pelvic adhesions?
- I have chronic pelvic pain. Could this be related to adhesions?
- What is uterine retroversion (retroverted uterus)
- Does a retroverted uterus (backward tilted uterus) cause symptoms?
- How is a retroverted uterus - backward tilted uterus - treated?
- What is pelvic congestion?
- What causes pain associated with sexual intercourse (dyspareunia)
- How can painful sexual intercourse (dyspareunia) be treated?
- What is a pelvic mass?
IRRITABLE BOWEL SYNDROME - IBS
- What is irritable bowel syndrome?
- How can we find out if I have irritable bowel syndrome?
- Is irritable bowel syndrome (IBS) a common condition?
- What causes IBS?
- What is the pain associated with IBS like?
- Can IBS be mistaken for gynaecological problems?
- How can my IBS be treated?
- What other treatments are available for IBS?
- What can be done to reduce the amount of bowel gas(flatus)
- What is constipation?
- What causes constipation?
- How can constipation be treated?
- How could we summarise the treatments that are available for my pelvic pain?
- Where can I obtain more information?
- Pelvic Pain Support Groups.
- Endometriosis Support Groups.
- IBS Support Groups.
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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
- Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - www.2womenshealth.com - to provide detailed
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