The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study

  • Tarek Shokeir
  • Mostafa Amr
  • Mahmoud Abdelshaheed
Original Article



To evaluate the beneficial effects of Implanon on pelvic pain in women with pelvic congestion syndrome (PCS). The efficacy of pain control, amount and frequency of menstrual loss, degree of patient’s satisfaction and objective pelvic venography scores were investigated.


In a prospective open-labelled study, 25 consecutive women complaining of chronic pelvic pain were recruited. Pretreatment objective peruterine venography and diagnostic laparoscopy of pure PCS together with subjective pelvic pain scores, prefilled questionnaire of Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), verbal rating scale (VRS) and quantified menstrual loss using the pictorial blood loss chart were documented in all cases. After identification, 23 subjects with pure PCS were randomly assigned to have either Implanon inserted subcutaneously (12 cases) or no treatment (11 cases). Patients were followed up at 1, 3, 6, 9 and 12 months. A symptom diary for side effects, VAS, VRS and menstrual scores were used to assess the subjective response to treatment. At the end of the study, all patients underwent repeat venography to assess the long-term objective response. After 12 months, subjects having Implanon inserted were requested to rate their overall degree of satisfaction with therapy.


All 25 women recruited in the study completed follow-up. Two cases were excluded from the study and referred to the psychiatry department after a negative evaluation for disease and HADS scores relevant for depression. An improvement in symptoms was observed throughout the 12 months amongst the Implanon group versus no treatment. The greatest changes in pain assessed using either the VAS or VRS were between the pretreatment scores and those after 6 months (7.7 ± 1.3 vs. 4.6 ± 3.0 for VAS, P < 0.001; and 25 ± 13.8 vs. 19 ± 18.9 for VRS, P < 0.002). The monthly quantified blood loss fell from 204 (196) pretreatment to 90 (157) at 6 months (P < 0.001) and then to 64 (32) at 9 months (P < 0.002). Objective repeat venography score was reduced significantly at 1 year after treatment compared with the baseline evaluation as well as with the control group (4.5 ± 1.2 vs. 8.6 ± 0.5; P = 0.001 and 4.2 ± 0.9 vs. 8.5 ± 0.6; P = 0.0002, respectively). At final satisfaction assessment, 2 (17%) women were very satisfied 8 (66%) were satisfied, and 2 (17%) were uncertain. The implant was retained by all women at the end of the study.


Implanon seems to be an effective hormonal alternative for long-term treatment of properly selected patients with pure PCS-related pelvic pain.


Implanon Pelvic congestion syndrome Pelvic pain Treatment 


Conflict of interest statement

There is no actual or potential conflict of interest in relation to this article.


  1. 1.
    Nicholson T, Basile A (2006) Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol 9:19–23. doi: 10.1053/j.tvir.2006.08.005 PubMedCrossRefGoogle Scholar
  2. 2.
    Cheong Y, William Stones R (2006) Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol 20:695–711. doi: 10.1016/j.bpobgyn.2006.04.004 PubMedCrossRefGoogle Scholar
  3. 3.
    Lukanova M, Popov I (2008) Chronic pelvic pain and combined oral hormonal contraception. Akush Ginekol (Sofiia) 47:20–29Google Scholar
  4. 4.
    Ferrero S, Ragni N, Remorgida V (2008) Deep dyspareunia: causes, treatments, and results. Curr Opin Obstet Gynecol 20:394–399PubMedCrossRefGoogle Scholar
  5. 5.
    Beard RW, Reginald PW, Wadsworth J (1988) Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol 95:153–161PubMedGoogle Scholar
  6. 6.
    Simsek M, Burak F, Taskin O (2007) Effects of micronized purified flavonoid fraction (Daflon) on pelvic pain in women with laparoscopically diagnosed pelvic congestion syndrome: a randomized crossover trial. Clin Exp Obstet Gynecol 34:96–98PubMedGoogle Scholar
  7. 7.
    Beard RW, Reginald PW, Pearce S (1986) Pelvic pain in women. Br Med J (Clin Res Ed) 283:160–162Google Scholar
  8. 8.
    Soysal ME, Soysal S, Vicdan K, Ozer S (2001) A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Hum Reprod 16:931–939. doi: 10.1093/humrep/16.5.931 PubMedCrossRefGoogle Scholar
  9. 9.
    Farquhar CM, Rogers V, Franks S, Pearce S, Wadsworth J, Beard RW (1989) A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. Br J Obstet Gynaecol 96:1153–1162PubMedGoogle Scholar
  10. 10.
    Reginald PW, Adams J, Franks S, Wadsworth J, Beard RW (1989) Medroxyprogesterone acetate in the treatment of pelvic pain due to venous congestion. Br J Obstet Gynaecol 96:1148–1152PubMedGoogle Scholar
  11. 11.
    Wagner MS, Arias RD, Nucatola DL (2007) The combined etonogestrel/ethinyl estradiol contraceptive vaginal ring. Expert Opin Pharmacother 8:1769–1777. doi: 10.1517/14656566.8.11.1769 PubMedCrossRefGoogle Scholar
  12. 12.
    Power J, French R, Cowan F (2007) Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev 3:CD 001326Google Scholar
  13. 13.
    Gezginc K, Balci O, Karatayli R, Colak-Oglu MC (2007) Contraceptive efficacy and side effects of Implanon. Eur J Contracept Reprod Health Care 16:1–4Google Scholar
  14. 14.
    Affandi B (1998) An integrated analysis of vaginal bleeding patterns in clinical trials of Implanon. Contracept Suppl 58:99–101CrossRefGoogle Scholar
  15. 15.
    Higham J, O’Brien PM, Shaw RW (1990) Assessement of menstrual loss using a pictorial chart. Br J Obstet Gynaecol 97:734–739PubMedGoogle Scholar
  16. 16.
    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x PubMedCrossRefGoogle Scholar
  17. 17.
    Adams J, Reginald PW, Franks S, Wadsworth J, Beard RW (1990) Uterine size and endometrial thickness and the significance of cystic ovaries in women with pelvic pain due to congestion. Br J Obstet Gynaecol 97:583–587PubMedGoogle Scholar
  18. 18.
    Stones RW, Mountfield J (2000) Interventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev (4):CD 000387Google Scholar
  19. 19.
    Pilawski Z, Sieja K, kosmider M (1987) Pelvic congestion as a symptom of psychsomatic disorders. Pol Tyg Lek 42:1156–1158PubMedGoogle Scholar
  20. 20.
    Beard R, Reginald P, Pearce S (1988) Psychological and somatic factors in women with pain due to pelvic congestion. Adv Exp Med Biol 245:413–421PubMedGoogle Scholar
  21. 21.
    Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R (2007) Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol 30:1105–1111. doi: 10.1007/s00270-007-9160-0 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Tarek Shokeir
    • 1
  • Mostafa Amr
    • 2
  • Mahmoud Abdelshaheed
    • 3
  1. 1.Fertility Care Unit, Department of Obstetrics and Gynecology, Mansoura Faculty of MedicineMansoura University HospitalMansouraEgypt
  2. 2.Department of Psychiatry, Mansoura Faculty of MedicineMansoura University HospitalMansouraEgypt
  3. 3.Department of Diagnostic Radiology, Mansoura Faculty of MedicineMansoura University HospitalMansouraEgypt

Personalised recommendations