Long-term Efficacy and Safety of Levonorgestrel - releasing Intrauterine System in the Treatment of Adenomyosis: Evidence Mapping and Meta-analysis

Shi J, Jinghua Shi, 知子 谷, Gu Z, Wu Y, Yu Wu, Li X, Xiaoyan Li, Jing Zhang, Zhang J, Chenyu Zhang, Zhang C, Hai Yan, Yan H, Yi Dai, Dai Y, Leng J, Jinhua Leng, Shuangzheng Jia
In: Authorea, Inc. · 2022 · doi:10.22541/au.165276725.52323745/v1 · W4280654594
Systematic review / meta-analysis preprint OA: gold CC0
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This meta-analysis found that the levonorgestrel-releasing intrauterine system effectively reduces dysmenorrhea and bleeding in adenomyosis patients and shows significant long-term benefits as post-operative therapy.

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Abstract

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

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Condition tags

adenomyosisdysmenorrhea

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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