The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis

Paolo Vercellini, Paola Viganò, Edgardo Somigliana
Current opinion in obstetrics & gynecology · 2005 · vol. 17(4) , pp. 359–365 · doi:10.1097/01.gco.0000175353.03061.7f · PMID:15976541 · W2026520459
review OA: closed CC0 ⤵ 49 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Levonorgestrel intrauterine devices induce endometrial atrophy and reduce bleeding, effectively relieving pelvic pain from endometriosis with potentially localized effects and limited systemic adverse events.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.

My notes (saved in your browser only)

Condition tags

mesh:D004412mesh:D004414mesh:D004715mesh:D017699endometriosisbowel_endometriosisdysmenorrheadyspareunia

MeSH descriptors

Contraceptive Agents, Female Endometriosis Intrauterine Devices, Medicated Levonorgestrel Contraceptive Agents, Female Contraceptive Agents, Female Dysmenorrhea Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Dyspareunia Endometriosis Endometriosis Female Humans Levonorgestrel Levonorgestrel Pelvic Pain Pelvic Pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (33)

Cited by (49)

Source provenance

europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:15:35.797702+00:00
unpaywall
last seen: 2026-06-02T02:00:03.124865+00:00
License: CC0 · commercial use OK