Evaluation of efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS) in pain management of endometriotic patients

Objectives: In women with endometriosis who undergo laparoscopic cystectomy and adhesiolysis to compare efficacy of post-operative insertion of LNG IUS in reduction of pelvic pain and menorrhagia. Also, to compare the effect of LNG IUS insertion in improving quality of life score in these patients. Methods: This was a prospective interventional study on 52 women with stage 3 or 4 endometriosis who underwent laparoscopic cystectomy and adhesiolysis were allocated alternatively to either LNG IUS (n=26) or expectant management (n=26). VAS (Visual analogue scale), PGWBI (Psychological general well being index), MBS (Mean bleeding score) were used for objective assessment of pelvic pain, quality of life and menstrual bleeding respectively at the time of enrollment to study along with baseline parameters. Patients were called for review at 1st, 3rd and 6th month and parameters were compared in both groups. Additionally, it was notes if any additional analgesic was needed for pain relief in either group or any new complication developed during study period. Results: VAS score decreased significantly more in the study group from 6.92±2.04 to 2.60±0.92 by 6th month post insertion whereas in control group baseline score of 6.42±1.88 decreased to 4.42±0.99 at 6th month (p=<0.001). PGWBI scores were slightly better in the control group (45.73±10.80) than study group at the time of enrollment and this trend continued 1 month post insertion (47.08±10.59), difference was not statistically significant (p baseline =0.390, p 1 month=0.563). In study group PGWBI score improved from 43.00±11.88 (baseline) to 45.35±10.65 at 1st month and by 6th month scores improved significantly to 56.62±8.17. At 6th month control group PGWBI score was at 51.38±9.42. This difference was statistically significant (p=0.037). MBS of study group decreased from 3.20±0.51 at baseline to 2.02±0.42 by 6th month post LNG IUS insertion; MBS of control group decreased from baseline of 3.07±0.59 to 2.76±0.56 at 6th month (p<0.001). Conclusion: Patients with endometriosis have poor quality of life due to constant pain and irregular heavy cycles. It is beneficial to insert LNG IUS as it improves the quality of life most importantly, even in patients undergoing surgical treatment for the same.