Eficácia do sistema liberador de levonorgestrel no tratamento da dor pélvica crônica associada a endometriose / Efficacy of levonorgestrel-releasing system in the treatment of chronic pelvic pain associated with endometriosis
DOI:
https://doi.org/10.34119/bjhrv5n2-007Keywords:
dor pélvica crônica, endometriose, levonorgestrel.Abstract
A dor pélvica crônica associada à endometriose acomete de 3 a 10% das mulheres em idade reprodutiva. Diversos são os modelos hoje propostos para o tratamento de tal problemática, incluindo métodos hormonais de administração oral. No entanto, tais métodos apresentam um amplo rol de efeitos adversos. O presente artigo busca revisar a literatura para avaliar a eficácia de um sistema intrauterino de liberação de levonorgestrel no tratamento da dor pélvica crônica associada à endometriose, evidenciando as adversidades e a melhora na qualidade de vida dos pacientes. Os autores utilizaram os termos de pesquisa “levonorgestrel” AND “endometriosis” nas bases PubMed (MEDLINE), SciELO, BVS e LILACS. A partir disso, o número de artigos foi delimitado por meio de critérios de inclusão e exclusão tais como língua de publicação e tipo de estudo. Na pesquisa inicial foram identificadas 512 referências, das quais 223 eram duplicatas, 85 não estavam na língua inglesa ou portuguesa e 182 não seguiam o tipo de literatura desejada, sobrando assim 22 estudos. Conclusão: Apesar do tratamento da endometriose ainda não ser totalmente elucidado, concluiu-se que o uso do dispositivo intrauterino liberador de levonorgestrel é eficaz em seu tratamento sintomático, incluindo a dor pélvica crônica associada. O uso da droga pela via citada promove um menor grau de efeitos adversos a curto prazo, visto que promove efeito predominantemente local.
References
- Tanmahasamut P, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Indhavivadhana S, Leerasiri P. Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial. Obstet Gynecol. 2012. Available from:https://doi: 10.1097/AOG.0b013e31824264c3
- Petta CA, Ferriani RA, Abrao MS, Hassan D, Rosa E Silva JC, Podgaec S, Bahamondes L. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod. 2005. Available from: https://doi: 10.1093/humrep/deh869.
- Lockhat FB, Emembolu JO, Konje JC. The evaluation of the effectiveness of an intrauterine-administered progestogen (levonorgestrel) in the symptomatic treatment of endometriosis and in the staging of the disease. Hum Reprod. 2004. Available from: https://doi: 10.1093/humrep/deh004.
- Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011. Available from: https://doi: 10.1016/j.fertnstert.2010.08.042.
- Lockhat FB, Emembolu JO, Konje JC. The efficacy, side-effects and continuation rates in women with symptomatic endometriosis undergoing treatment with an intra-uterine administered progestogen (levonorgestrel): a 3 year follow-up. Hum Reprod. 2005. Available from: https://doi: 10.1093/humrep/deh650.
- Gomes MK, Ferriani RA, Rosa e Silva JC, Japur de Sá Rosa e Silva AC, Vieira CS, Cândido dos Reis FJ. The levonorgestrel-releasing intrauterine system and endometriosis staging. Fertil Steril. 2007. Available from: https://doi: 10.1016/j.fertnstert.2006.11.044.
- Vercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani PG. Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril. 2003 Aug;80(2):305-9. doi: 10.1016/s0015-0282(03)00608-3. PMID: 12909492.
- Lockhat FB, Emembolu JE, Konje JC. Serum and peritoneal fluid levels of levonorgestrel in women with endometriosis who were treated with an intrauterine contraceptive device containing levonorgestrel. Fertil Steril. 2005. Available from: https://doi: 10.1016/j.fertnstert.2004.07.961.
- Carvalho N, Margatho D, Cursino K, Benetti-Pinto CL, Bahamondes L. Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial. American Society for Reproductive Medicine. 2018. Avaiable from: .https://doi: 10.1016/j.fertnstert.2018.07.003
- Wong AY, Tang LC, Chin RK. Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010. Available from: https://doi: 10.1111/j.1479-828X.2010.01152.x.
- Morelli M, Sacchinelli A, Venturella R, Mocciaro R, Zullo F. Postoperative administration of dienogest plus estradiol valerate versus levonorgestrel-releasing intrauterine device for prevention of pain relapse and disease recurrence in endometriosis patients. J Obstet Gynaecol Res. 2013. Available from: https://doi: 10.1111/jog.12030
- Vercellini P, Aimi G, Panazza S, De Giorgi O, Pesole A, Crosignani PG. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Fertil Steril. 1999. Available from: https://doi: 10.1016/s0015-0282(99)00291-5.
- Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril. 2001. Available from: https://doi: 10.1016/s0015-0282(00)01759-3.
- Yucel N, Baskent E, Karamustafaoglu Balci B, Goynumer G. The levonorgestrel-releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 2018. Available from: https://doi: 10.1111/ajo.12773
- Egekvist AG, Marinovskij E, Forman A, Kesmodel US, Graumann O, Seyer-Hansen M. Conservative treatment of rectosigmoid endometriosis: A prospective study. Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). 2019. Available from: https://doi: 10.1111/aogs.13619.
