A Cochrane review [Abstract] 1 included 4 RCTs with a total of 157 women. There was a reduction in the recurrence of painful periods in the LNG-IUS group compared with expectant management (delta of median visual analogue scale (VAS) 81 versus 50 in two trials, P=0.006, n=55; and the fall in VAS was 50 (35 to 65) versus 30 (25 to 40) in a third trial, P=0.021, n=40). The proportion of women who were satisfied with their treatment was higher in the LNG-IUD group than in the control group (75% vs 50% in one trial and more women were "very satisfied" in another trial).
A meta-analysis 2 included 4 RCTs (n=212), 1 prospective cohort study (n=88), and 2 retrospective studies (n=191). Efficacy of LNG-IUS was compared with other treatments as a postoperative maintenance therapy. LNG-IUS was effective in reducing pain after surgery (MD = 12.97, 95% CI 5.55 to 20.39), with a comparable effect to gonadotropin-releasing hormone analogues (MD = -0.16, 95% CI -2.02 to 1.70). LNG-IUS was also effective in decreasing the recurrence rate (RR = 0.40, 95% CI 0.26 to 0.64), with an effect comparable to oral contraceptives (OR = 1.00, 95% CI 0.25 to 4.02), and danazol (RR = 0.30, 95% CI 0.03 to 2.81). Furthermore, patients' satisfaction with LNG-IUS was significantly higher than that with oral contraceptives (OR = 8.60, 95% CI 1.03 to 71.86). However, vaginal bleeding was significantly higher in the LNG-IUS group than in the gonadotropin-releasing hormone analogue group (RR = 27.0, 95% CI 1.71 to 425.36).
Comment: The quality of evidence is downgraded by study quality (unclear blinding of participants and personnel).
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