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

Abstract

The 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. We searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane CentralRegister 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. Ten prospective studies (patients n=551) were included. The overall effect estimates showed that the LNG-IUS led to significant reductions in pain score after 12months (standardized mean difference [SMD[ -3.87, 95% confidence interval [CI] -5.51 to -2.23, P<.001), 24months (SMD -5.56, 95% CI -9.80 to -1.32, P=.01) and 36months 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 36months 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 12months (SMD -.60, 95% CI -0.88 to -.31, P<.001) and 36months after insertion (SMD -0.42, 95% CI -0.69 to -0.14, P=.003). LNG-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.