Comparison of post-operative use of levonorgestrel-intrauterine system and cyclic oral contraceptive for prevention of endometrioma recurrence

Abstract

The objective of this study is to compare the efficacy of postoperative use of levonorgestrel-releasing intrauterine system (LNG-IUS) and oral contraceptive for prevention of endometrioma recurrence. Retrospective study. Retrospective review of medical records of 141 reproductive-aged patients who had undergone laparoscopic surgery for endometrioma from January 2009 to December 2011 was performed. Patients were divided into two groups: a group that had postoperative LNG-IUS inserted (N=42) and a group that received postoperative cyclic, low-dose, monophasic oral contraceptives(OC) (N=99). Endometrioma recurrence was evaluated by an ultrasound. Mean age of LNG-IUS group and OC group was 40.26±4.40 and 32.97±5.56 and the difference was statistically significant (P<0.001). During the follow-up period (median, 17 months), recurrent endometriomas were detected in 13 patients (9.2%). Patients with LNG-IUS had recurrence rate of 4.8%(2/42), where patients receiving OC had recurrence rate of 11.1%(11/99). Cumulative recurrence-free survival revealed mean disease-free survival for LNG-IUS group and OC group were 34.44±1.01 months (95% CI: 33.11-35.90) and 33.41±0.98 months (95% CI: 31.42-35.35), respectively (P=0.015). Univariate analysis revealed hazard ratio (HR) of 0.168 (95% CI: 0.034-0.821) (P=0.028) for postoperative LNG-IUS use and endometrioma recurrence. However, on multivariate regression analysis, only postoperative serum CA-125 levels were significantly associated with endometrioma recurrence (HR:1.009, P=0.011). We demonstrated that post-operative use of LNG-IUS can be as effective as cyclic OC in prevention of endometrioma recurrence.