Effectiveness of hormonal intrauterine system in treatment of pelvic congestion syndrome compared to oral progestin

Purpose: To compare levonorgestrel-releasing intrauterine system (LNG-IUS) with oral progestin in reducing pain associated with pelvic congestion syndrome (PCS). Methods: A comparative cohort study included 104 patients with PCS who allocated to LNG-IUS (Group 1, n = 52) or oral norethisterone acetate 10 mg twice daily (Group 2, n = 52). Follow-up was carried out for 4 months from starting treatment. Pelvic pain was assessed by the Visual Analog Scale (VAS) and the ovarian and uterine vein diameter was assessed by pelvic Doppler ultrasound. The primary outcome was the improvement of pelvic pain. The secondary outcomes included the need for additional pain treatment, pelvic veins’ diameters, and the menstrual flow. Results: More patients in LNG-IUS had experienced lower degrees of pain severity by VAS compared to oral progestin ( p = 0.029). The posttreatment pain relief was positively correlated with pretreatment pain severity in LNG-IUS ( p = 0.039) and oral progestin group ( p = 0.0001) while it was negatively correlated with pretreatment uterine vein diameter in oral progestin group ( p = 0.01). The need for additional pain treatment was less with LNG-IUS ( p = 0.049). Compared to pretreatment, both LNG-IUS and oral progestin resulted in decrease in ovarian ( p = 0.044 and 0.013, respectively) and uterine vein diameters ( p = 0.001 and 0.001, respectively). The posttreatment menstrual blood flow was lighter in LNG-IUS group ( p = 0.1). Conclusions: LNG-IUS is more effective in relieving pain in PCS compared with oral progestin. This effect cannot be attributed solely to decrease in pelvic veins’ diameters. These promising results underscore the need for randomized studies with longer follow-up to demonstrate sustainable effectiveness.