Jon Matthew Farber, MD

Published in Journal of Pediatric and Adolescent Gynecology

The answer to this question appears to be “yes,” according to a study indicating that 92% of 221 adolescents with endometriosis who underwent placement of a levonorgestrel-releasing intrauterine device (LNG-IUD) continued to use the device 1 year later. Most of the patients who were followed had stage 1 endometriosis, and 94.1% continued using hormone therapy (HT), most often norethindrone acetate, after surgery or first began using it postoperatively. Only 18 (8%) of participants had their IUD removed by the 1-year mark, with a median time to removal of 118 days.

The 1-year LNG-IUD continuation rate for those who received postsurgical HT was 93.3% compared with 69.2% for those who did not continue the HT regimen. Investigators therefore concluded that the use of additional HT was associated with a reduced likelihood of IUD removal within the first year after insertion.

THOUGHTS FROM DR FARBER

Bottom line, previous surgery for endometriosis is not a contraindication to the use of an IUD (usually with HT) if the patient and you agree that this is the best option. If you feel comfortable, you can insert it, or have your gynecology colleagues do so, depending on your practice’s approach.

Reference:

Shim JY, Milliren CE, DiVasta AD. Continuation of the levonorgestrel-releasing intrauterine device among adolescents with endometriosis. J Pediatr Adolesc Gynecol. 2025;38(1):85-88. doi:10.1016/j.jpag.2024.10.005