Hum Reprod. 2005 Jul;20(7):1993-8.
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.
Petta CA, Ferriani RA, Abrao MS, Hassan D, Rosa E Silva JC, Podgaec S, Bahamondes L.
Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. cpetta@attglobal.net
Background:
The objective of this multicentre randomized, controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months.
Methods:
Eighty-two women, 18 to 40 years of age (mean 30 years), with endometriosis, dysmenorrhoea and/or CPP, were randomized using a computer-generated system of sealed envelopes into either LNG-IUS (n = 39) or GnRH analogue (n = 43) treatment groups at three university centres. Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale (VAS), daily bleeding score was calculated from bleeding calendars, and improvement in quality of life was evaluated using the Psychological General Well-Being Index Questionnaire (PGWBI). The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis. A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period.
Results:
CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups (P > 0.999). In both treatment groups, women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease (P < 0.002). LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34% and 71% of patients in the LNG-IUS and GnRH-analogue groups, respectively, reporting no bleeding during the first treatment month, and 70% and 98% reporting no bleeding during the sixth month. No difference was observed between groups with reference to improvement in quality of life.
Conclusions:
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.
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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