Clinical question
Is the use of a post‐operative levonorgestrel‐releasing intrauterine device (LNG‐IUD) effective and safe for women with symptomatic endometriosis?
Bottom line
There is very little evidence determining the effectiveness of post‐operative LNG‐IUD for reducing pain caused by endometriosis, so this review was unable to draw any substantial conclusions. No trials reported on overall pain or chronic pelvic pain at 12 months. Two small trials did show that post‐operative LNG‐IUD improved dysmenorrhoea at 12 months, and 1 trial showed that participants were satisfied with the treatment.
Caveat
There were significant increases in bloating and melasma among those who received post‐operative LNG‐IUD compared with no post‐operative treatment, but this was based on 1 very small study. All the available data came from 4 small trials that only included 153 women in total. All 4 trials were at high risk of bias due to lack of blinding.
Context
Endometriosis is a condition characterised by ectopic deposits of endometrial‐like tissue outside the uterus, usually in the pelvis, that can lead to infertility and pelvic pain. The impact of laparoscopic treatment on overall pain is uncertain, and a significant proportion of women require further surgery. Therefore, adjuvant medical therapies following surgery, such as the LNG‐IUD, have been considered to reduce recurrence of symptoms.
Cochrane Systematic Review
Gibbons T, et al. Levonorgestrel‐releasing intrauterine device (LNG‐IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev 2021;12:CD005072. This review contains 4 trials with a total of 153 participants.
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