Background:  Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long‐term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel‐releasing intrauterine system (LNG‐IUS) may be a useful form of prolonged progestogen therapy for endometriosis.
Aims:  To evaluate and compare the efficacy and safety of LNG‐IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients’ acceptance.
Methods:  A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG‐IUS and 15 had three‐monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student’s t‐test and chi‐square test.
Results:  Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG‐IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG‐IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm2) than Depot MPA users (−0.030, −0.017 g/cm2) in both hip and lumbar regions.
Conclusions:  Levonorgestrel‐releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG‐IUS users showed a better compliance. After three years, bone gain was noted with LNG‐IUS, but bone loss with depot MPA.