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Long-term Efficacy and Safety of Levonorgestrel - releasing Intrauterine System in the Treatment of Adenomyosis: Evidence Mapping and Meta-analysis
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  • Jinghua Shi,
  • Zhi Gu,
  • Yu Wu,
  • Xiaoyan Li,
  • Jing Zhang,
  • Chen-Yu Zhang,
  • Hai Yan,
  • Yi Dai,
  • Jinhua Leng
Jinghua Shi
Peking Union Medical College Hospital

Corresponding Author:[email protected]

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Xiaoyan Li
Chinese Academy of Medical Sciences and Peking Union Medical College
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Jing Zhang
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Chen-Yu Zhang
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Jinhua Leng
Pecking Union Medical College Hospital
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Background: Adenomyosis (AM) is a common benign gynaecologic disease characterized by dysmenorrhea and heavy menstrual bleeding and requires for long-term management. Levonorgestrel - releasing Intrauterine System (LNG-IUS) is a long-acting hormone-releasing uterine device which has benefits in relieving pain and reducing bleeding. Objectives: To summarise the current available evidence regarding the LNG-IUS for the treatment of AM and to identify potential research gaps. Search Strategy: We performed a systematic search in electronic databases including MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI and Wanfang. Selection Criteria: We included studies of adult patients with a diagnosis of AM and focused on treatments with the LNG-IUS combined with conservative therapy. Data Collection and Analysis: A random-effects model was used for meta-analysis. Quality and risk of bias were assessed using the Newcastle Ottawa Scale for non-RCTs and Cochrane risk of bias tool for RCTs. Main Results: Thirty-nine studies compared the LNG-IUS with other conservative therapeutic drugs, and 32 studies investigated LNG-IUS as the post-operative therapeutic management. In patients who received conservative therapies, the most reported comparison was GnRHa+LNG-IUS versus LNG-IUS alone, followed by LNG-IUS versus mifepristone, gestrinone, blank control, GnRH-a, and androgen. Conclusions: Compared with COC and GnRHa, LNG-IUS could maintain a long-term effect in reducing dysmenorrhea and bleeding. Combined therapeutic treatment with GnRH-a and LNG-IUS was more efficacious than LNG-IUS alone in patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, in patients undergoing post-operative therapy, the LNG-IUS showed a significant long-term benefit. Keywords: LNG-IUS evidence mapping adenomyosis