Volume 50, Issue 3 p. 273-279

Levonorgestrel-releasing intrauterine system (Mirena®) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: A randomised controlled trial

Alice Yuen Kwan WONG

Alice Yuen Kwan WONG

Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong, China

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Lawrence Chang Hung TANG

Lawrence Chang Hung TANG

Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong, China

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Robert Kien Howe CHIN

Robert Kien Howe CHIN

Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong, China

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First published: 15 June 2010
Citations: 56
Dr. Alice Yuen Kwan Wong, Department of Obstetrics & Gynecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong, China. Email: [email protected]

The study has been presented as free communication in the 11th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), Paris, France, 27–30 November 2008.

Abstract

Background: Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long-term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel-releasing intrauterine system (LNG-IUS) may be a useful form of prolonged progestogen therapy for endometriosis.

Aims: To evaluate and compare the efficacy and safety of LNG-IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients’ acceptance.

Methods: A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG-IUS and 15 had three-monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student’s t-test and chi-square test.

Results: Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG-IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG-IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm2) than Depot MPA users (−0.030, −0.017 g/cm2) in both hip and lumbar regions.

Conclusions: Levonorgestrel-releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG-IUS users showed a better compliance. After three years, bone gain was noted with LNG-IUS, but bone loss with depot MPA.