Uterine Ultrasonographic Changes During Endometriosis Treatment: A Comparison Between Levonorgestrel-Releasing Intrauterine Devices and a Gonadotropin-Releasing Hormone Agonist

Manetta LA, Luiz Alberto Manetta, Wellington P. Martins, de Paula Martins W, Wellington de Paula Martins, Júlio César Rosa e Silva, Ana Carolina Japur de Sá Rosa e Silva, de Sá Rosa e Silva AC, Nogueira AA, Antônio Alberto Nogueira, Rui Alberto Ferriani, Ferriani RA
Ultrasound in medicine & biology · 2008 · vol. 34(12) , pp. 1914–1918 · doi:10.1016/j.ultrasmedbio.2008.04.013 · PMID:18597921 · W2163943419
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This study compared ultrasonographic changes in the uterus of patients with endometriosis treated with either a levonorgestrel-releasing intrauterine device or a gonadotropin-releasing hormone agonist.

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Abstract

We compared the effects of levonorgestrel-releasing intrauterine devices (LNG-IUD) and a gonadotropin-releasing hormone agonist (GnRHa) on uterine volume, uterine arteries pulsatility index (PI) and endometrial thickness before and after six months of endometriosis treatment. Sixty women aged 18-40 y were allocated randomly to one of two groups: LNG-IUDs were inserted in 30 women, and GnRHa monthly injections were performed on the other 30. All 60 women were submitted to transvaginal 2-D ultrasound scans on the day that the treatment started and then six months later. Measurements of uterine arteries PI, uterine volume and endometrial thickness were performed at both evaluations. The use of LNG-IUDs significantly decreased endometrial thickness (pre = 6.08 +/- 3.00 mm, post = 2.7 +/- 0.98 mm; mean +/- SD), as did the use of GnRHa (pre = 6.96 +/- 3.82 mm, post = 3.23 +/- 2.32 mm). The uterine volume decreased in the GnRHa group (pre = 86.67 +/- 28.38 cm(3), post = 55.27 +/- 25.52 cm(3)), but not in the LNG-IUD group (pre = 75.77 +/- 20.88 cm(3), post = 75.97 +/- 26.62 cm(3)). Uterine arteries PI increased for both groups; however, the increase was higher in the GnRHa group (0.99 +/- 0.84 vs. 0.38 +/- 0.84, p = 0.007; PI increase in GnRHa and in LNG-IUD groups, respectively). In conclusion, levonorgestrel released directly onto the endometrium by the LNG-IUD induced smaller uterine changes than did the hypoestrogenism induced by GnRHa. Nevertheless, both promoted similar effects on endometrial thickness.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Leuprolide Levonorgestrel Uterine Diseases Adolescent Adult Endometriosis Endometriosis Endometriosis Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Intrauterine Devices, Medicated Leuprolide Leuprolide Levonorgestrel Levonorgestrel Pulsatile Flow Pulsatile Flow

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