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

Paolo Vercellini, Vercellini P, Paola Viganò, Viganò P, Edgardo Somigliana, Somigliana E
Current opinion in obstetrics & gynecology · 2005 · vol. 17(4) , pp. 359–365 · doi:10.1097/01.gco.0000175353.03061.7f · PMID:15976541 · W2026520459
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Levonorgestrel intrauterine devices induce endometrial atrophy and reduce bleeding, effectively relieving pelvic pain from endometriosis with potentially localized effects and limited systemic adverse events.

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This review evaluates the biological rationale and clinical efficacy of the levonorgestrel-releasing intrauterine device for managing symptomatic endometriosis. The authors note that the device induces endometrial atrophy and has anti-inflammatory effects, leading to significant reductions in pelvic pain associated with peritoneal and rectovaginal lesions. While it effectively reduces blood loss and dysmenorrhea risk after surgery, the paper highlights a need for further trials to confirm long-term benefits over five years and assess its impact on dyspareunia. This paper is centrally about endometriosis — specifically the use of a levonorgestrel-releasing intrauterine device for pain management and symptom relief.

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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.
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The role of the levonorgestrel-releasing intrauterine device in the management of symptomatic endometriosis - Paolo Vercellini - Paola Viganò - Edgardo Somigliana Purpose of review The aim of this article is to evaluate the biological rationale for the use of an intrauterine device releasing 20 μg/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.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_painbowel_endometriosis

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

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