Abstract
Objective: To evaluate the clinical effectiveness of a dual progestogen-delivery system (DPS) using a levonorgestrel-releasing intrauterine system (LNG-IUS) combined with an etonogestrel subdermal implant (ESI) in women with severe, refractory endometriosis-associated pelvic pain. Design: A retrospective analysis of 105 patients treated with simultaneous LNG-IUS and ESI for durations ranging from 24 to 102 months. Setting: Tertiary referral centers and university-affiliated hospitals. Patients: Women with surgically confirmed endometriosis and persistent pelvic pain unresponsive to standard care (medical and/or surgical management). Main Outcome Measures: Pain relief (measured by VAS), continuation rates, treatment duration, and reported adverse events. Results: The mean treatment duration was 28.1 months. Significant pain reduction was reported in 85% of patients, with VAS scores decreasing from a baseline mean of 9/10 to 3/10 (SD ± 1.04) by 3 months, and to minimal or no pain by 6 months. Most patients (n = 90/105, 85%) sustained symptom relief throughout therapy. Mild adverse effects were reported in 50% of patients, though primarily mild and non-disruptive. Conclusion: The DPS represents a promising, alternative, long-term therapeutic option for managing severe, refractory endometriosis-related pain, offering both uterine and systemic suppression of endometriotic activity.