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

Abstract

ObjectiveAlthough 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. DesignA retrospective cohort study. SettingMedical university hospital. PopulationNinety-nine women with endometriomas. MethodsA 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 measuresEndometrioma recurrence was analyzed according to several clinical variables and postoperative treatment modalities. ResultsDuring the follow-up period (median 17months), 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 (34.41.0months, 95% confidence interval 32.3-36.5, vs. 33.4 +/- 1.3months, 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 CA125 levels were significantly associated with endometrioma recurrence (hazard ratio 1.012, p=0.010). ConclusionsPostoperative LNG-IUS use seemed to be comparable to the use of cyclic OC in preventing endometrioma recurrence.