Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma: a systematic review.
A systematic review is done to determine the efficacy and safety of levonorgestrel-releasing intrauterine systems as a treatment using in premenopausal women with symptomatic uterine leiomyoma. We searched the Medline, Central and ICTRP databases for all articles published from inception through July 2013 that examined the following outcomes: uterine volume, uterine leiomyoma volume, endometrial thickness, then menstrual blood loss, blood haemoglobin, ferritin and hematocrit levels, treatment failure rate, device expulsion rate, hysterectomy rate and side effects. From 645 studies, a total of 11 studies met our inclusion criteria with sample sizes ranging from 10 to 104. Evidence suggested that levonorgestrel-releasing intrauterine systems could decrease uterine volume and endometrial thickness, significantly reduce menstrual blood loss, and increase blood haemoglobin, ferritin and hematocrit levels. There was no evidence for decreasing uterine leiomyoma volume. There were no adverse effects on the ovarian function except for ovarian cysts. Device expulsion rates were low, which associated with leiomyoma size (larger than 3cm) but not with leiomyoma location. Irregular bleeding/spotting was observed at the beginning of the follow-up period and then decreased progressively. Results of this systematic review indicate that levonorgestrel-releasing intrauterine systems may be effective and safe treatment for symptomatic uterine leiomyoma in premenopausal women.
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: jiangwenxiao@163.com.
Wenxiao
W
Jiang
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: wzlunwen@163.com.
Qi
Q
Shen
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: mmcwzmc@163.com.
Miaomiao
M
Chen
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: wy815161578@163.com.
Ying
Y
Wang
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: mickeyzqf@126.com.
Qingfeng
Q
Zhou
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China. Electronic address: zxj1022@163.com.
Xuejie
X
Zhu
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China. Electronic address: zjwzzxq@163.com.
Xueqiong
X
Zhu
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D004343:Drug Implants; D004354:Drug Screening Assays, Antitumor; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use*; D017697:Premenopause; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology; D014599:Uterus / Q000378:metabolism*
D018931:Antineoplastic Agents, Hormonal; D004343:Drug Implants; D016912:Levonorgestrel
Endometrial thickness; Leiomyoma volume; Levonorgestrel-releasing intrauterine systems; Uterine leiomyoma; Uterine volume