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

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.

We searched PubMed, Cochrane and Scopus databases from 2000 to November 2019 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 10cm-visual analogue scale, and uterine volume. 

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), ( 3.68; CI: 2.11-5.25), twelve months (SMD: 4.23; CI: 2.99-5.48), 24 months (SMD: 4.69; CI: 3.40-5.97) and 36 months (SMD: 4.01; CI: 3.57-4.45); significant reduction in menstrual bleeding after six months (SMD: 2.52; CI: 1.15-3.89), twelve months (SMD: 3.43; CI: 1.64-5.22) and 24 months (SMD: 3.57; CI: 1.88-5.26); significant reduction in uterine volume after six months (SMD: 0.49; CI: 0.04-0.93), twelve months (SMD: 0.80; CI: 0.11-1.48) and 24 months (SMD: 0.86; CI: 0.15-1.58). 

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.