Evaluation of Levonorgestrel-releasing intrauterine system (LNG) in the management of uterine adenomyosis-An update systematic review and metanalysis

Background and Objective: Adenomyosis is a common benign endometrial disease which causes abnormal uterine bleeding in premenopausal women and affects the quality of life.  The definitive treatment is hysterectomy, however medical treatment is an option for those who wish to preserve fertility. This systematic review aims to assess the efficacy of levonorgestrel-releasing intrauterine device as medical management in women who have adenomyosis.Methods: We searched PubMed, Cochrane and Scopus databases from ۲۰۰۰ to November ۲۰۱۹ for relevant studies containing the use of levonorgestrel-releasing intrauterine device (LNG-IUD) in managing patients with ultrasonographic diagnosed adenomyosis. Main outcomes measures in the study are menstrual blood loss (milliliters), pain score measured in ۱۰cm-visual analogue scale, and uterine volume. Results: Pooled results from meta-analysis showed that after LNG-IUD treatment for adenomyosis, there is significant reduction in dysmenorrhoea measured using Visual Analogue Scale after six months Standardized Mean Difference (SMD), ( ۳.۶۸; CI: ۲.۱۱-۵.۲۵), twelve months (SMD: ۴.۲۳; CI: ۲.۹۹-۵.۴۸), ۲۴ months (SMD: ۴.۶۹; CI: ۳.۴۰-۵.۹۷) and ۳۶ months (SMD: ۴.۰۱; CI: ۳.۵۷-۴.۴۵); significant reduction in menstrual bleeding after six months (SMD: ۲.۵۲; CI: ۱.۱۵-۳.۸۹), twelve months (SMD: ۳.۴۳; CI: ۱.۶۴-۵.۲۲) and ۲۴ months (SMD: ۳.۵۷; CI: ۱.۸۸-۵.۲۶); significant reduction in uterine volume after six months (SMD: ۰.۴۹; CI: ۰.۰۴-۰.۹۳), twelve months (SMD: ۰.۸۰; CI: ۰.۱۱-۱.۴۸) and ۲۴ months (SMD: ۰.۸۶; CI: ۰.۱۵-۱.۵۸). Conclusion LNG-IUS is an effective method in alleviating the symptoms of adenomyosis.  It is a valuable long-term alternative for the treatment of adenomyosis for young and perimenopausal women in terms of dysmenorrhoea and heavy menstrual bleeding.

کلیدواژه ها:

Levonorgestrel-releasing intrauterine system ، Adenomyosis ، menstrual blood loss ، Dysmenorrhea