Levonorgestrel-Releasing Intrauterine Device: An Effective Treatment for Symptoms of Persistent Pelvic Pain.

Background: Persistent pelvic pain (PPP) affects 5%-27% of women of reproductive age. The calls for earlier and improved access to surgery to diagnose endometriosis do not address the requirement for symptom management and exclude the 50% of women who undergo a laparoscopy for identical pain symptoms but do not have endometriosis identified. Moreover, current evidence for the management of pelvic pain almost exclusively focuses on patients diagnosed with endometriosis.

Aims: To investigate the pain scores and overall satisfaction with symptom control in participants with PPP who utilised the levonorgestrel-intrauterine device 52 mg (LNG-IUD), to explore the association between time since last menstrual period (LMP) and other potential factors, including the impact of surgery and surgical findings, on pain outcomes.

Materials and methods: This prospective cohort study recruited participants between February 2015 and December 2017 following outpatient clinic referral for pelvic pain symptoms (dysmenorrhea, non-cyclic pelvic pain, dysuria, dyspareunia or dyschezia). Over 18 months, 72 participants had an LNG-IUD (52 mg) inserted, with 51 completing a follow-up questionnaire 6-18 months after insertion to assess pain outcomes.

Results: Dysmenorrhoea (coefficient = -0.142, p < 0.001) and overall satisfaction with symptom control (coefficient = 0.079, p = 0.020) scores improved linearly with increased months since LMP in LNG-IUD users. In multivariate analysis, the age of onset of symptoms, laparoscopies prior to study entry or during the study period, and a histological diagnosis of endometriosis did not have a significant relationship with pain outcome or overall satisfaction with symptom control.

Conclusions: This study demonstrates that menstrual suppression with the LNG-IUD, regardless of a diagnosis of endometriosis, significantly improves a woman's overall satisfaction with PPP management. The LNG-IUD is an effective first-line medical management option for patients presenting with PPP.