Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study

Purpose Progestins are successfully employed as treatment for endometriosis. Our study evaluates the effects of the etonogestrel (ENG) implant on pelvic pain, quality of life, and sexual function in women requiring long-term reversible contraception and presenting ovarian cysts of probable endometriotic origin.

We enrolled 25 women asking for contraception with the ENG implant and presenting a cyst with the ultrasound features of an endometrioma and pain symptoms. Patients were interviewed on pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria) using a VAS score (0–10), on quality of life (QoL) using the Short Form-36 questionnaire, and on sexual activity using the Female Sexual Function Index (FSFI) questionnaire before inserting the implant (T0) and after 6 (T1) and 12 months (T2).

We found a significant decrease in dysmenorrhea and dyspareunia VAS scores comparing baseline scores to 6 and 12 months. After 12 months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. The total FSFI score results increased in comparison with baseline both at 6 and 12 months. In particular, we highlighted a significant improvement in desire, satisfaction, and pain domains already at 6 months; the arousal domain improved only after 12 months. Finally, mean diameters of endometrioma-like cysts were not changed after 12 months of treatment.

Etonogestrel implants seem to be able to reduce pelvic pain, improve sexual function, and quality of life in patients with ovarian cysts suspected of endometriotic origin. Similar content being viewed by others

Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10:261–275. https://doi.org/10.1038/nrendo.2013.255 Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68:585–596. https://doi.org/10.1016/S0015-0282(97)00191-X Laganà AS, Vitale SG, Salmeri FM et al (2017) Unus pro omnibus, omnes pro uno: a novel, evidence-based, unifying theory for the pathogenesis of endometriosis. Med Hypotheses. https://doi.org/10.1016/j.mehy.2017.03.032 Maniglio P, Ricciardi E, Laganà AS et al (2016) Epigenetic modifications of primordial reproductive tract: a common etiologic pathway for Mayer–Rokitansky–Kuster–Hauser Syndrome and endometriosis? Med Hypotheses. https://doi.org/10.1016/j.mehy.2016.02.015 Rakhila H, Al-Akoum M, Bergeron ME et al (2016) Promotion of angiogenesis and proliferation cytokines patterns in peritoneal fluid from women with endometriosis. J Reprod Immunol 116:1–6. https://doi.org/10.1016/j.jri.2016.01.005 Vetvicka V, Laganà AS, Salmeri FM et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-016-4195-6 Laganà AS, Triolo O, Salmeri FM et al (2016) Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-015-4004-7 Koga K, Takamura M, Fujii T, Osuga Y (2015) Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril 104:793–801. https://doi.org/10.1016/j.fertnstert.2015.08.026 Crosignani PG, Olive D, Bergqvist A, Luciano A (2006) Advances in the management of endometriosis: an update for clinicians. Hum Reprod Update 12:179–189. https://doi.org/10.1093/humupd/dmi049 Dunselman GAJ, Vermeulen N, Becker C et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29:400–412. https://doi.org/10.1093/humrep/det457 Olive DL, Pritts EA (2002) The treatment of endometriosis: a review of the evidence. Ann N Y Acad Sci 955:360–372 Vercellini P, Fedele L, Pietropaolo G et al (2003) Progestogens for endometriosis: forward to the past. Hum Reprod Update 9:387–396. https://doi.org/10.1093/humupd/dmg030 Vercellini P, Crosignani P, Somigliana E et al (2011) ’Waiting for Godot: a commonsense approach to the medical treatment of endometriosis. Hum Reprod 26:3–13. https://doi.org/10.1093/humrep/deq302 Berlanda N, Somigliana E, Viganò P, Vercellini P (2016) Safety of medical treatments for endometriosis. Expert Opin Drug Saf 15:21–30. https://doi.org/10.1517/14740338.2016.1121991 Mäkäräinen L, Van Beek A, Tuomivaara L et al (1998) Ovarian function during the use of a single contraceptive implant: implanon compared with Norplant. Fertil Steril 69:714–721. https://doi.org/10.1016/S0015-0282(98)00015-6 Blumenthal PD, Gemzell-Danielsson K, Marintcheva-Petrova M (2008) Tolerability and clinical safety of Implanon®. Eur J Contracept Reprod Heal Care 13:29–36. https://doi.org/10.1080/13625180801960012 Yisa SB, Okenwa AA, Husemeyer RP (2005) Treatment of pelvic endometriosis with etonogestrel subdermal implant (Implanon®). J Fam Plan Reprod Heal Care 31:67–70. https://doi.org/10.1783/0000000052972799 Walch K, Unfried G, Huber J et al (2009) Implanon® versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis—a pilot study. Contraception 79:29–34. https://doi.org/10.1016/j.contraception.2008.07.017 Royal College of Obstetricians and Gynaecologist (2006) Endometriosis, investigation and management. RCOG Green- top Guideline No. 24 von Elm E, Altman DG, Egger M et al (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008 Ware JE Jr, Kosinski M, Gandek B et al (1998) The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1159–1165 Nappi RE, Albani F, Vaccaro P et al (2008) Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice. Gynecol Endocrinol 24:214–219. https://doi.org/10.1080/09513590801925596 Di Carlo C, Guida M, De Rosa N et al (2015) Bleeding profile in users of an etonogestrel sub-dermal implant: effects of anthropometric variables. An observational uncontrolled preliminary study in Italian population. Gynecol Endocrinol 31:491–494. https://doi.org/10.3109/09513590.2015.1018163 Gezer A, Oral E (2015) Progestin therapy in endometriosis. Women’s Heal 11:643–652. https://doi.org/10.2217/whe.15.42 Vercellini P, Pietropaolo G, De Giorgi O et al (2005) Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 84:1375–1387. https://doi.org/10.1016/j.fertnstert.2005.03.083 Schlaff WD, Carson SA, Luciano A et al (2006) Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertil Steril 85:314–325. https://doi.org/10.1016/j.fertnstert.2005.07.1315 Crosignani PG, Luciano A, Ray A, Bergqvist A (2006) Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 21:248–256. https://doi.org/10.1093/humrep/dei290 Strowitzki T, Faustmann T, Gerlinger C, Seitz C (2010) Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 151:193–198. https://doi.org/10.1016/j.ejogrb.2010.04.002 Harada T, Momoeda M, Taketani Y et al (2009) Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis-a randomized, double-blind, multicenter, controlled trial. Fertil Steril 91:675–681. https://doi.org/10.1016/j.fertnstert.2007.12.080 Vercellini P, Bracco B, Mosconi P et al (2016) Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril 105:734–743e3. https://doi.org/10.1016/j.fertnstert.2015.11.016 Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S (2011) Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril 95:492–496. https://doi.org/10.1016/j.fertnstert.2010.08.042 Ylänen K, Laatikainen T, Lähteenmäki P, Moo-Young AJ (2003) Subdermal progestin implant (Nestorone®) in the treatment of endometriosis: clinical response to various doses. Acta Obstet Gynecol Scand 82:167–172. https://doi.org/10.1034/j.1600-0412.2003.00054.x Wenzl R, Van Beek A, Schnabel P, Huber J (1998) Pharmacokinetics of etonogestrel released from the contraceptive implant Implanon®. Contraception 58:283–288. https://doi.org/10.1016/S0010-7824(98)00110-3 Meckstroth KR, Darney PD (2001) Implant contraception. Semin Reprod Med 19:339–354. https://doi.org/10.1055/s-2001-18642 Varma R, Mascarenhas L (2001) Endometrial effects of etonogestrel (Implanon) contraceptive implant. Curr Opin Obstet Gynecol 13:335–341. https://doi.org/10.1097/00001703-200106000-00015 Van Den Bosch T, Donders GGG, Riphagen I et al (2002) Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant. Ultrasound Obstet Gynecol 20:377–380. https://doi.org/10.1046/j.1469-0705.2002.00816.x Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS (2008) The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Heal Care 13:13–28. https://doi.org/10.1080/13625180801959931 Bazot M, Daraï E, Biau DJ et al (2011) Learning curve of transvaginal ultrasound for the diagnosis of endometriomas assessed by the cumulative summation test (LC-CUSUM). Fertil Steril 95:301–303. https://doi.org/10.1016/j.fertnstert.2010.08.033 Funding This study was not supported by any grant/fund. Author information Authors and Affiliations Contributions AS: manuscript writing. NR: data collection. PG: manuscript writing. MG: data collection. ASL: manuscript editing. CC: project supervision. Corresponding author Ethics declarations Conflict of interest The authors have no proprietary, financial, professional, or other personal interest of any nature in any product, service, or company. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Rights and permissions About this article Cite this article Sansone, A., De Rosa, N., Giampaolino, P. et al. Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study. Arch Gynecol Obstet 298, 731–736 (2018). https://doi.org/10.1007/s00404-018-4851-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-018-4851-0