Characteristics of women with recurrent endometriosis pain after laparoscopy and levonorgestrel intrauterine device placement

Introduction: The levonorgestrel (LNG)-intrauterine device (IUD) is effective for many, but not all, women with endometriosis in managing pelvic pain. The aim of this study was to explore the characteristics associated with recurrent endometriosis pain within 12 months after operative laparoscopy and LNG-IUD placement. Methods: This retrospective case series was performed at a university-affiliated infertility and reproductive surgery practice and included women who underwent operative laparoscopy and LNG-IUD placement by a single surgeon from January 1, 2012 to October 7, 2015 (n = 32). Within 12 months post-operatively, the primary surgeon assessed pain reported by the patient and prescribed adjunctive oral hormonal therapy for recurrent pain symptoms. Data were collected using the patients’ electronic medical records. The main outcome was the presence of recurrent endometriosis pain within 12 months after operative laparoscopy with LNG-IUD placement. Results: Of the 32 women who underwent laparoscopy and LNG-IUD placement, 26 presented for follow-up (81.2%) within 12 months, 15 of whom (57.7%) reported recurrent pain. The odds of poor pain control were higher among the women who were obese, among those who had undergone prior laparoscopy, and among those with a history of asthma, depression, or headaches. Conclusions: The optimal management of endometriosis-related pain is highly patient-specific, and poor response to LNG-IUD may be associated with having had a prior laparoscopy, obesity, and certain medical comorbidities.