Use of the Levonorgestrel Intrauterine System in Adolescents with Endometriosis

Abstract Study Objective The purpose of this study was to evaluate our adolescent patient population who had received a levonorgestrel intrauterine system (LNG-IUS) at or after the time of endometriosis diagnosis, and determine efficacy of the LNG-IUS in regards to pain and bleeding on follow-up exa...

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Bibliographic Details
Published in:Journal of pediatric & adolescent gynecology 2013-04, Vol.26 (2), p.120-124
Main Authors: Yoost, Jennie, MD, LaJoie, A. Scott, PhD, MSPH, Hertweck, Paige, MD, Loveless, Meredith, MD
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Adult
Cohort Studies
Combined Modality Therapy
Contraceptive Agents, Female - administration & dosage
Drug Therapy, Combination
Endometriosis
Endometriosis - complications
Endometriosis - drug therapy
Female
Follow-Up Studies
Hemorrhage - drug therapy
Hemorrhage - etiology
Humans
Intrauterine Devices, Medicated
Levonorgestrel - administration & dosage
Levonorgestrel intrauterine system
Obstetrics and Gynecology
Pain - drug therapy
Pain - etiology
Pediatrics
Pelvic pain
Retrospective Studies
Treatment Outcome
Young Adult
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Summary:Abstract Study Objective The purpose of this study was to evaluate our adolescent patient population who had received a levonorgestrel intrauterine system (LNG-IUS) at or after the time of endometriosis diagnosis, and determine efficacy of the LNG-IUS in regards to pain and bleeding on follow-up exam. Design Retrospective cohort study. Setting Pediatric Adolescent Gynecology Clinic and Children's Hospital in a metropolitan area. Participants Adolescent patients age 14–22 with pathology-proven endometriosis who had the LNG-IUS placed during the course of their treatment for this disease. Patients were divided into LNG-IUS placement at the time of surgical diagnosis versus placement some time after diagnosis. Main Outcome Measures Pain and bleeding were assessed by follow-up exam. Pain was classified at each follow-up visit as either none, minimal, moderate, or severe. Bleeding was classified as none, irregular spotting, irregular bleeding, or daily bleeding. Results The majority of patients (67%) required additional hormonal therapy for pain and bleeding suppression. Time to bleeding suppression and pain suppression was sooner in the group with interval time between surgical diagnosis and LNG-IUS placement, compared to LNG-IUS placement at the time of surgery (2.4 months vs 5.3 months until bleeding suppression, and 3.8 months vs 4.8 months until pain suppression), although statistical significance was not achieved. Conclusions The LNG-IUS is an option for treatment of endometriosis in adolescents. As pain is the main problem associated with endometriosis, LNG-IUS placement is beneficial at the time of surgery when it is diagnosed. A prospective study is needed for further assessment of outcomes.
ISSN:1083-3188
1873-4332
DOI:10.1016/j.jpag.2012.11.002