Levonorgestrel, Pharmacokinetics, Efficacy and Safety 47intervention every five years [67]. Fifty-nine percent of the women in the
LNG-IUD group were still using the IUD after 36 months. The VAS pain
score in this group was 0–3 (indicating excellent pain control) in 82.6%, and
≥7 in only 8.6%. In the former users of the GnRH analogue, 28% were using
some form of hormonal contraceptives to control pain, and 47.5% continued to
have excellent pain control, while only 2.5% had a pain score ≥7. While both
treatments are effective in pain control for up to 3 years, the LNG-IUD has an
additional benefit that it provides contraceptive protection along with good
pain control [68]. Lockhart et al. reported significant pain improvement with
LNG- IUD in women with minimal to moderate endometriosis. 34 women
were treated with the LNG-IUD for up to 36 months. There was a decrease in
the visual analog pain scale (VAS) from an initial score of 7.7/10 to 2.7 at 36
months. There was also a decrease in the verbal rating scale (VRS) of both
dysmenorrhea and noncyclic pelvic pain from an initial 25/96 to 8.4 after 36
months as well as a decrease in total days of pain per 28-day period from 15.0
to 6.0 after 12 months [69].
LNG-IUD is also effective in preventing recurrence of endometriosis after
conservative surgical treatment for moderate to severe endometriosis. In a
randomized-controlled clinical trial of 40 women, 20 women were treated
postoperatively with LNG-IUD while 20 women who were managed
expectantly following conservative surgical treatment for moderate to severe
endometriosis. After 12 months, women who received the LNG-IUD had a
recurrence rate of 10% of moderate to severe endometriosis, compared with a
recurrence rate of 45% in the expectantly managed group. There was also an
absolute risk reduction in recurrence of dysmenorrhea in the LNG-IUD group
of 35%, as well as a decrease in the recurrence rates of dyspareunia [70].
The LNG-IUD is an effective treatment for the relief of pain associated
with endometriosis, requires fewer interventions, has fewer hypoestrogenic
side effects and results in increased patient satisfaction compared to other
alternative treatments.
Adenomyosis
Adenomyosis is a relatively common disorder affecting women, usually in
their 40s and 50s. The symptoms include menorrhagia (40%–50%),
dysmenorrhea (15%–30%), and metrorrhagia (10%–12%) [71]. Traditionally
hysterectomy has been the definitive treatment but over last several years less
invasive treatments have been tried. The less invasive treatment options
include endometrial ablation, danazol and GnRH agonists. Endometrial