Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis

Objective: To evaluate the effectiveness of a levonorgestrel-releasing IUD as therapy for endometriosis of the rectovaginal septum. Design: Prospective therapeutic non-randomized, self-controlled clinical tr ial analyzing changes in pain symptoms and size of lesions induced by the l evonorgestrel-releasing IUD over 12 months. Setting: Tertiary referral center for treatment of deep endometriosis. Patient(s): Eleven symptomatic patients with rectovaginal endometriosis. Intervention(s): A levonorgestrel-releasing IUD was inserted and maintained for 12 months. Main Outcome Measure(s): Severity of dysmenorrhea, pelvic pain, and deep dy spareunia were assessed before insertion of the IUD and throughout treatmen t. The size of rectovaginal endometriotic lesions were evaluated by using t ransrectal and transvaginal ultrasonography. Result(s): Dysmenorrhea, pelvic pain, and deep dyspareunia greatly improved and the size of the endometriotic lesions was significantly reduced by tre atment. Conclusion(s): Insertion of a levonorgestrel-releasing IUD alleviates pain and reduces the size of lesions in patients with endometriosis of the recto vaginal septum. (C) 2001 by American Society for Reproductive Medicine.