The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

Ahmed M. Abbas; Ahmed Samy; Khaled Atwa; Hanan M. Ghoneim; Mariam Lotfy; Heba Saber Mohammed; Asmaa M. Abdellah; Amira M. El Bahie; Ahmed A. Aboelroose; Asmaa M. El Gedawy; Mona Mostafa; Mohamed A. Elsenity; Mohammed Samy; Sarah Safwat; Rehab M. Abdelrahman; Adel S. Salah El Din; Esraa Badran; Abdelrahman M. Abdelkader; Ameer Abdallah

doi:10.1111/aogs.13798

journal article Jan 24, 2020

The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

Ahmed M. Abbas

Ahmed Samy

Khaled Atwa Hanan M. Ghoneim Mariam Lotfy Heba Saber Mohammed Asmaa M. Abdellah Amira M. El Bahie Ahmed A. Aboelroose Asmaa M. El Gedawy

Mona Mostafa Mohamed A. Elsenity Mohammed Samy Sarah Safwat

Rehab M. Abdelrahman Adel S. Salah El Din Esraa Badran Abdelrahman M. Abdelkader Ameer Abdallah

Acta Obstetricia et Gynecologica Scandinavica Vol. 99 No. 5 pp. 571-581 · Wiley

View at Publisher Save 10.1111/aogs.13798

Abstract

AbstractIntroductionThe levonorgestrel intrauterine system (LNG‐IUS) is a long‐acting hormone‐releasing uterine device that has many non‐contraceptive benefits. The study aims to assess the safety and efficacy of LNG‐IUS in the management of adenomyosis.Material and methodsWe searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Google Scholar for the relevant studies which used LNG‐IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis.The main outcome measures are pain score at the end of follow‐up, bleeding, symptomatic relief, uterine volume (mL), endometrial thickness (mm) and/or hemoglobin level.ResultsTen prospective studies (patients n = 551) were included. The overall effect estimates showed that the LNG‐IUS led to significant reductions in pain score after 12 months (standardized mean difference [SMD[ −3.87, 95% confidence interval [CI] −5.51 to −2.23, P < .001), 24 months (SMD −5.56, 95% CI −9.80 to −1.32, P = .01) and 36 months of insertion (SMD −3.81, 95% CI −4.27 to −3.36, P < .001). Similarly, the Pictorial Blood Assessment Chart (PBAC) showed significant reduction up to 36 months after LNG‐IUS insertion (SMD −2.32, 95% CI −2.91 to −1.73, P < .001). The LNG‐IUS led to significant reductions in the uterine volume 12 months (SMD −.60, 95% CI −0.88 to −.31, P < .001) and 36 months after insertion (SMD −0.42, 95% CI −0.69 to −0.14, P = .003).ConclusionsLNG‐IUS is a promising and effective option for the management of adenomyosis. Its use effectively reduced the severity of symptoms, uterine volume and endometrial thickness, and improved laboratory outcomes.

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Metrics

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Citations

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References

Details

Published: Jan 24, 2020
Vol/Issue: 99(5)
Pages: 571-581
License: View

Authors

A

Ahmed M. Abbas

Department of Obstetrics and Gynecology Faculty of Medicine Assiut University Assiut Egypt

A

Ahmed Samy

Department of Obstetrics and Gynecology Faculty of Medicine Cairo University Cairo Egypt

K

Khaled Atwa