Endometriosis-associated pain scores and biomarkers in users of the etonogestrel-releasing subdermal implant or the 52-mg levonorgestrel-releasing intrauterine system for up to 24 months

Eur J Contracept Reprod Health Care. 2020 Apr;25(2):133-140. doi: 10.1080/13625187.2020.1725461. Epub 2020 Feb 18.


Objectives: The aims of the study were to correlate endometriosis-associated pain, evaluated by visual analogue scale (VAS) scores, with serum levels of etonogestrel (ENG), levonorgestrel (LNG), CA-125 and soluble CD23 in users of the ENG implant or the 52-mg LNG-releasing intrauterine system (52 mg LNG-IUS) for up to 2 years after device placement.Methods: A randomised trial was conducted at the University of Campinas Medical School, Brazil. All participants (n = 103) had had endometriosis-associated chronic pelvic pain or dysmenorrhoea, or both, for more than 6 months. Participants were randomly assigned to use an ENG implant (experimental treatment) or a 52-mg LNG-IUS (active comparator). Follow-up was conducted 6 monthly for up to 24 months after device placement. Dysmenorrhoea and chronic pelvic pain were evaluated using a VAS and the scores were correlated with serum levels of ENG, LNG, CA-125 and soluble CD23.Results: Both progestin-only contraceptives significantly reduced VAS scores for dysmenorrhoea and chronic pelvic pain and reduced serum levels of soluble CD23 (p < 0.001). Serum levels of CA-125 decreased only in the ENG implant group after 24 months' use of the device (p < 0.001). No correlation was found between pain scores and ENG or LNG serum levels over time (p > 0.005).Conclusion: Both contraceptives improved dysmenorrhoea and chronic pelvic pain scores in women with endometriosis-associated pain and they reduced serum levels of soluble CD23; however, serum levels of CA-125 were reduced only in ENG implant users over the 24-month study period.

Keywords: 52-mg levonorgestrel-releasing intrauterine system; Biomarkers; CA-125; chronic pelvic pain; endometriosis; etonogestrel implant; soluble CD23.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Brazil
  • CA-125 Antigen / blood
  • Desogestrel / administration & dosage
  • Desogestrel / therapeutic use*
  • Drug Implants
  • Dysmenorrhea / drug therapy
  • Dysmenorrhea / etiology
  • Endometriosis / complications
  • Endometriosis / drug therapy*
  • Female
  • Humans
  • Intrauterine Devices, Medicated
  • Levonorgestrel / administration & dosage
  • Levonorgestrel / therapeutic use*
  • Middle Aged
  • Pain Measurement
  • Pelvic Pain / drug therapy
  • Pelvic Pain / etiology
  • Young Adult


  • CA-125 Antigen
  • Drug Implants
  • etonogestrel
  • Levonorgestrel
  • Desogestrel