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#Grand Rounds

Comparing IUD vs Implant for the Management of Endometriosis

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BACKGROUND AND PURPOSE:

  • Carvalho et al. (Fertility & Sterility, 2018) compared the efficacy of an etonogestrel (ENG)-releasing contraceptive implant and the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) to treat endometriosis-associated pelvic pain

METHODS:

  • Noninferiority randomized clinical trial
  • Participants
    • Surgically and histologically confirmed diagnosis of stage I–IV endometriosis or diagnosis of deep endometriosis based on transvaginal ultrasonography and MRI
    • Complaints of noncyclic chronic pelvic pain and/or dysmenorrhea >6 months
  • Study period: 180 Days
  • Randomized to
    • Experimental treatment: ENG implant (Implanon NXT)
    • Active comparator: LNG-IUS (Mirena)
  • Monthly follow-up visits up to 6 months
    • Daily scores of noncyclic pelvic pain and dysmenorrhea were evaluated using a daily visual analogue scale
      • VAS scale: From 0 (no pain) to 10cm (the worst pain imaginable)
    • Health-related quality of life was evaluated using the Endometriosis Health Profile-30 questionnaire at baseline and up to 6 months
  • Bleeding patterns were assessed daily using a menstrual calendar
  • Primary outcomes: Change in endometriosis-associated
    • Noncyclic pelvic pain
    • Dysmenorrhea
  • Secondary outcomes
    • Health related quality of life | Bleeding patterns | Adverse Events
  • Statistics: A minimum sample size of 45 women per study arm to achieve noninferiority
    • 0.05 significance level | Power of 0.80

RESULTS:

  • 52 in ENG group | 51 in LNG-IUS group
  • No significant difference between treatments for noncyclic pelvic pain and dysmenorrhea

Both contraceptives significantly improved the mean visual analogue scale endometriosis-associated pelvic pain and dysmenorrhea over 180 study days

  • Noncyclic pelvic pain
    • ENG implant: Mean difference: 5.6 ± 1.7 (95% CI −6.4, −4.7)
    • IUD: Mean Difference: 5.5 ± 1.6; 95% CI −6.2, −4.4)
    • P<.0001 for both groups
  • Dysmenorrhea
    • ENG implant: Mean difference: 5.3 ± 1.3 (95% CI −6.6, −4.3)
    • IUD: Mean difference: 5.4 ± 1.3 (95% CI −6.3, −4.3)
    • P<.0001 for both groups
  • Health-related quality of life improved significantly in all domains for both groups
  • Most common bleeding patterns at 180 days follow-up
    • ENG implant: Amenorrhea and infrequent bleeding
  • LNG-IUS users: Infrequent bleeding and spotting

CONCLUSION:

  • Both ENG and LNG-IUS result in improved pelvic pain, dysmenorrhea, and health-related quality of life in women with endometriosis

Learn More – Primary Sources:

Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial

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Related ObG Topics:

Evaluation and Treatment of Endometriosis
Alleviation of Endometriosis Symptoms: Laparoscopic Excision or Ablation?
Does the Oral GnRH Antagonist Elagolix Improve Endometriosis-Associated Pain?

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