Introduction: 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.
Material and methods:We 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.Results: 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 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).
Conclusions: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.
K E Y W O R D Sadenomyosis, hormonal intrauterine device, levonorgestrel intrauterine system, pain relief
