Postoperative levonorgestrel‐releasing intrauterine system versus oral contraceptives after gonadotropin‐releasing hormone agonist treatment for preventing endometrioma recurrence

Sihyun Cho, Ji Ann Jung, Yousun Lee, Hye Yeon Kim, Seok Kyo Seo, Young Sik Choi, Ji Sung Lee, Byung Seok Lee
Acta obstetricia et gynecologica Scandinavica · 2013 · vol. 93(1) , pp. 38–44 · doi:10.1111/aogs.12294 · PMID:24605384 · W2021451858
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This retrospective study found that postoperative levonorgestrel-releasing intrauterine system use was comparable to oral contraceptives in preventing endometrioma recurrence, with a slightly longer disease-free survival for the LNG-IUS group.

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Abstract

OBJECTIVE: Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is effective in reducing the recurrence of endometriosis-associated pain, its efficacy in preventing endometrioma recurrence is questionable. We compared the efficacy of postoperative use of LNG-IUS with oral contraceptives (OC) for preventing endometrioma recurrence. DESIGN: A retrospective cohort study. SETTING: Medical university hospital. POPULATION: Ninety-nine women with endometriomas. METHODS: A chart review was performed of women of reproductive age who had undergone laparoscopic surgery for endometrioma followed by three cycles of gonadotropin-releasing hormone agonist (leuprolide acetate) treatment. Women were categorized into two groups: a group that had postoperative LNG-IUS placement (n = 42) and a group that received postoperative, cyclic, low-dose, monophasic, OCs (n = 57). Main outcome measures. Endometrioma recurrence was analyzed according to several clinical variables and postoperative treatment modalities. RESULTS: During the follow-up period (median 17 months), recurrent endometriomas were detected in eight women (8.1%). Patients with LNG-IUS had a recurrence rate of 4.8% (2/42), whereas women receiving OC had a recurrence rate of 10.5% (6/57). Cumulative recurrence-free survival assessment revealed that mean disease-free survival times for both groups were similar, but that for LNG-IUS was slightly longer than that for OC, with statistical significance (34.4 ± 1.0 months, 95% confidence interval 32.3–36.5, vs. 33.4 ± 1.3 months, 95% confidence interval 30.8–36.0, p = 0.045). Univariate analysis revealed a hazard ratio of 0.178 (95% confidence interval 0.029–1.075) (p = 0.060) for postoperative LNG-IUS use and endometrioma recurrence. However, for the multivariate regression analysis, only postoperative serum CA 125 levels were significantly associated with endometrioma recurrence (hazard ratio 1.012, p = 0.010). CONCLUSIONS: Postoperative LNG-IUS use seemed to be comparable to the use of cyclic OC in preventing endometrioma recurrence.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Contraceptives, Oral, Hormonal Endometriosis Intrauterine Devices, Medicated Leuprolide Levonorgestrel Adult Contraceptives, Oral, Hormonal Contraceptives, Oral, Hormonal Disease-Free Survival Endometriosis Endometriosis Endometriosis Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans Leuprolide Levonorgestrel Levonorgestrel Middle Aged

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