Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: evidence mapping

Purpose To summarize evidence on levonorgestrel releasing intrauterine system (LNG–IUS) in the treatment of adenomyosis (AM) and to identify potential research gaps.

Search was conducted in MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI, and Wanfang. We included studies investigating patients with AM treated with LNG–IUS combined with conservative therapy.

Thirty-nine studies compared LNG–IUS with other conservative therapeutic drugs. The most common comparison was GnRH-a + LNG–IUS vs. LNG–IUS alone, followed by LNG–IUS vs. mifepristone, expected treatment, and GnRH-a. GnRH-a + LNG–IUS was more beneficial in reducing the intensity of dysmenorrhea than LNG–IUS alone at the 6-month follow-up in patients with an enlarged uterus and moderate to severe dysmenorrhea. Large and well-designed studies are needed to confirm the efficacy of LNG–IUS and GnRH-a on reducing uterine volume at 6-month follow-up. Thirty-two studies investigated LNG–IUS as the postoperative management. The most common comparison was surgical excision + LNG–IUS vs. surgical excision. Results showed VAS scores were lower in the surgical excision + LNG–IUS group than in the surgical excision group at the 1-year follow-up. Evidence on endometrial thickness, quality of life, adverse events and beneficial effect at 3 and 5 years are needed.

Combined GnRH-a and LNG–IUS treatment was more efficacious than LNG–IUS alone for patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, LNG–IUS seemed to show potential long-term benefits in postoperative therapy, warranting further meta-analysis for confirmation. Similar content being viewed by others Data availability The data that support the findings of this study are available on request from the corresponding author. Abbreviations - LNG–IUS: - Levonorgestrel releasing intrauterine system - AM: - Adenomyosis - NSAIDs: - Nonsteroidal anti-inflammatory drugs - GnRH-a: - Gonadotropin-releasing hormone agonists - RRs: - Risk ratios - Cis: - Confidence intervals - MDs: - Mean differences - VAS: - Visual analogue scale - PBAC: - Pictorial blood loss assessment chart - COC: - Combined oral contraceptive - FUA: - Focused ultrasound ablation - UFS–QOL: - Uterine Fibroid Symptom and Health-related Quality Of Life questionnaire

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We thank Ms. Sai Zhao and Dr. Sitong Dong for their assistance in methodology. Funding None received. Author information Authors and Affiliations Contributions YD and JL contributed to the study conception and design. JS and ZG performed the literature search and study selection, XL, YW, HY, CZ and JZ performed the data extraction. ZG, XL, JS, YW and JZ performed the data summary. ZG, JL, JS and CZ prepared and wrote the manuscript. All authors were finally approval of manuscript. Corresponding author Ethics declarations Conflict of interests The authors declare that they have no conflict of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Shi, J., Gu, Z., Wu, Y. et al. Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: evidence mapping. Arch Gynecol Obstet 310, 55–67 (2024). https://doi.org/10.1007/s00404-024-07546-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-024-07546-7