Postoperative Levonorgestrel-Releasing Intrauterine System Insertion After Gonadotropin-Releasing Hormone Agonist Treatment for Preventing Endometriotic Cyst Recurrence: A Prospective Observational Study

Objective The aim of this study was to evaluate the effectiveness of postoperative levonorgestrel-releasing intrauterine system (LNG-IUS) insertion after gonadotropin-releasing hormone agonist (GnRH-a) treatment for preventing endometriotic cyst recurrence. Study Design The LNG-IUS was applied to 28 women who had undergone surgery for endometriosis followed by 6 cycles of GnRH-a treatment. Clinical characteristics, endometriosis recurrence, and adverse effects were analyzed. Student t test was performed for analysis.

Before surgery, 20 (71.4%) patients had dysmenorrhea, and the mean pain score (visual analog scale [VAS]) was 4.26. The numbers of women diagnosed with stage III endometriosis and stage IV endometriosis were 15 (53.6%) and 13 (46.4%), respectively, according to the revised American Fertility Society scoring system. The mean cancer antigen 125 levels and VAS scores were significantly lower after treatment than before treatment (11.61 vs 75.66 U/mL, P <.0001 and 0.50 vs 4.26 U/mL, P <.0001, respectively). Of the 28 patients, 13 (46.4%) simultaneously had adenomyosis, and 2 (7.1%) underwent LNG-IUS removal because of unresolved vaginal bleeding and dysmenorrhea. Recurrence was noted in 2 (7.1%) women.

Postoperative LNG-IUS insertion after GnRH-a treatment is an effective approach for preventing endometriotic cyst recurrence, especially in women who do not desire to conceive. Similar content being viewed by others

Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update. 2005;11(6):595–606. Winkel CA. Evaluation and management of women with endometriosis. Obstet Gynecol. 2003;102(2):397–408. Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol. 2004;16(4):299–303. Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009;15(4):441–461. Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011;95(2):492–496. Takamura M, Koga K, Osuga Y, et al. Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision. Hum Reprod. 2009;24(12):3042–3048. Loverro G, Carriero C, Rossi AC, Putignano G, Nicolardi V, Selvaggi L. A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage III–IV endometriosis. Eur J Obstet Gynecol Reprod Biol. 2008;136(2):194–198. Sesti F, Pietropolli A, Capozzolo T, et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III–IV. A randomized comparative trial. Fertil Steril. 2007;88(6):1541–1547. Lee DY, Bae DS, Yoon BK, Choi D. Post-operative cyclic oral contraceptive use after gonadotrophin-releasing hormone agonist treatment effectively prevents endometrioma recurrence. Hum Reprod. 2010;25(12):3050–3054. Park HJ, Koo YA, Yoon BK, Choi D. Postoperative long-term maintenance therapy with oral contraceptives after gonadotropin-releasing hormone analog treatment in women with ovarian endo-metrioma. J Minim Invasive Gynecol. 2009;16(1):34–39. Lee JY, Park SM, Ko YJ, Song YS. Necessity of education for oral contraceptive use in Korea: results from the fourth Korean national health and nutrition examination survey 2007–2009. Gynecol Obstet Invest. 2013;76(1):44–50. Wiebe ER, Henderson A, Choi J, Trouton K. Ethnic Korean women’s perceptions about birth control. Contraception. 2006;73(6):623–627. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014;10(3):CD009590. Morelli M, Sacchinelli A, Venturella R, Mocciaro R, Zullo F. Postoperative administration of dienogest plus estradiol valerate versus levonorgestrel-releasing intrauterine device for prevention of pain relapse and disease recurrence in endometriosis patients. J Obstet Gynaecol Res. 2013;39(5):985–990. Cho S, Jung JA, Lee Y, et al. Postoperative levonorgestrel-releasing intrauterine system versus oral contraceptives after gonadotropin-releasing hormone agonist treatment for preventing endometrioma recurrence. Acta Obstet Gynecol Scand. 2014;93(1):38–44. Exacoustos C, Zupi E, Carusotti C, et al. Staging of pelvic endometriosis: role of sonographic appearance in determining extension of disease and modulating surgical approach. J Am Assoc Gynecol Laparosc. 2003;10(3):378–382. Callen P. Ultrasonography in Obstetrics and Gynecology. 5th edition; Philadelphia, PA: Saunders, 2008:928. Koga K, Takamura M, Fujii T, Osuga Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril. 2015;104(4):793–801. Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol. 2005;12(6):508–513. Jinushi M, Arakawa A, Matsumoto T, et al. Histopathologic analysis of intestinal endometriosis after laparoscopic low anterior resection. J Minim Invasive Gynecol. 2011;18(1):48–53. Bulletti C, DeZiegler D, Stefanetti M, Cincinelli E, Pelosi E, Flamigni C. Endometriosis: absence of recurrence in patients after endometrial ablation. Hum Reprod. 2001;16(12):2676–2679. Goumenou AG, Chow C, Taylor A, Magos A. Endometriosis arising during estrogen and testosterone treatment 17 years after abdominal hysterectomy: a case report. Maturitas. 2003;46(3):239–241. Vercellini P, Somigliana E, Vigano P, Abbiati A, Barbara G, Fedele L. ‘Blood On The Tracks’ from corpora lutea to endometriomas. BJOG. 2009;116(3):366–371. DiVasta AD, Feldman HA, Sadler Gallagher J, et al. Hormonal add-back therapy for females treated with gonadotropin-releasing hormone agonist for endometriosis: a randomized controlled trial. Obstet Gynecol. 2015;126(3):617–627. Vercellini P, Somigliana E, Daguati R, Vigano P, Meroni F, Crosignani PG. Postoperative oral contraceptive exposure and risk of endometrioma recurrence. Am J Obstet Gynecol. 2008;198(5):504.e501–504.e505. Ouchi N, Akira S, Mine K, Ichikawa M, Takeshita T. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res. 2014;40(1):230–236. Perello MF, Martinez-Zamora MA, Torres X, Munros J, Balasch Cortina J, Carmona F. Endometriotic pain is associated with adenomyosis but not with the compartments affected by deep infiltrating endometriosis. Gynecol Obstet Invest. 2017;82(3):240–246. Petta CA, Ferriani RA, Abrao MS, et al. A 3-year follow-up of women with endometriosis and pelvic pain users of the levonorgestrel-releasing intrauterine system. Eur J Obstet Gynecol Reprod Biol. 2009;143(2):128–129. Kriplani A, Singh BM, Lal S, Agarwal N. Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Int J Gynaecol Obstet. 2007;97(3):190–194. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kim, M.K., Chon, S.J., Lee, J.H. et al. Postoperative Levonorgestrel-Releasing Intrauterine System Insertion After Gonadotropin-Releasing Hormone Agonist Treatment for Preventing Endometriotic Cyst Recurrence: A Prospective Observational Study. Reprod. Sci. 25, 39–43 (2018). https://doi.org/10.1177/1933719117718274 Published: Version of record: Issue date: DOI: https://doi.org/10.1177/1933719117718274