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The mirena IUD may diminish endometriosis-related dysmenorrhea. (Results of Two Small Studies).

SAN DIEGO -- A levonorgestrel-releasing intrauterine device reduced endometriosis-associated dysmenorrhea and pain in two European studies, investigators reported at the World Congress on Endometriosis.

In one study, 40 women with stage I-IV endometriosis and moderate or severe dysmenorrhea underwent first-line conservative laparoscopic surgery with excision or coagulation of endometriosis lesions. They were then randomized to a control group or to postoperative insertion of an IUD that releases 20 [micro]g/ day of 1evonorgestrel. Known as Mirena, the plastic T-shaped IUD is approved for use in the United States as a contraceptive and is made by Berlex Laboratories Inc.

Patients answered monthly pain questionnaires and came in for clinical examinations every 3 months in the yearlong trial. One patient in each group was lost to follow-up, and one patient in the IUD group spontaneously expelled the device after 5 months.

A total of 28% of the remaining 18 women who used the IUD were amenorrheic, 50% reported sporting, and 22% had normal menstrual flows. Patients in the control group had normal menstrual flows, Dr. Paolo Vercellini said at the meeting, which was sponsored by the World Endometriosis Society and the American Society for Reproductive Medicine.

Ten percent of women who used the IUD reported moderate or severe dysmenorrhea, compared with 45% of women in the control group, an absolute risk reduction of 35% using the IUD.

Surgery usually is effective in treating endometriosis-associated dysmenorrhea but relapses are "not rare," making the IUD a welcome adjunct to surgical treatment, said Dr. Vercellini of the University of Milan (Italy).

The IUD group reported significantly less dysmenorrhea, dyspareunia, and nonmenstrual pain on a visual analog scale and a verbal rating scale after treatment, compared with the control group. A total of 20% of the 20 patients in the IUD group reported side effects such as bloating, weight gain, and headache.

After 1 year, 75% of patients in the IUD group and 50% in the control group were satisfied or very satisfied with treatment, Dr. Vercellini said.

Investigators in a separate trial treated 25 women with suspected minimal to moderate endometriosis with the levonorgestrel-releasing IUD. All had moderate to severe dysmenorrhea with or without pelvic pain. Five patients had the device removed before the end of the yearlong study because of increasing pelvic pain, severe acne, or for personal reasons. In the remaining 20 patients, the number of painful days per month decreased significantly 6 and 12 months after insertion of the IUD, as did pain scores on the visual analog scale and the verbal report, Dr. Farhana Lockhat said at the meeting.

Dr. Lockhat's study was funded by Schering Health Care U.K., a division of the company that makes the IUD.
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Publication:OB GYN News
Date:May 15, 2002
Previous Article:Dioxins may play role in severity of endometriosis. (No Data in Humans).
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