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Evidence summaries

Progestogen-Releasing Intrauterine System for Uterine Fibroids

Progestogen-releasing intrauterine system (LNG-IUS) may reduce menstrual blood loss in premenopausal women with uterine fibroids. Level of evidence: "C"

Comment: The level of evidence is downgraded by study quality (unclear allocation concealment and blinding) and imprecise results (few patients).

Progestogen-releasing intrauterine system is suggested over oral contraceptives for the reduction of heavy menstrual bleeding in patients with uterine fibroids who do not accept surgical treatment.

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 221participants. There was a significant reduction of menstrual blood loss (MBL) in women receiving the LNG-IUS compared to the combined oral contraceptives using the alkaline hematin test (mean difference (MD) 77.5%, 95% CI 71.3% to 83.67%; n=44) and a pictorial assessment chart (MD 34.5%, 95% CI 12% to 57.1%; n=44). Compared with norethisterone acetate, LNG-IUS reduced MBL (visual bleeding score; MD 23.75 points, 95% CI 1.26 to 46.24; 1 RCT, n=45) and increased haemoglobin.

A systematic review 4 evaluated the efficacy and safety of LNG-IUS in premenopausal women with symptomatic uterine leiomyoma. 11 studies were included. LNG-IUS significantly reduced menstrual blood loss, and increased blood haemoglobin, ferritin and hematocrit levels. There was a trend towards decreased uterine volume and endometrial thickness. Uterine leiomyoma volume did not decrease. There were no adverse effects on the ovarian function except for ovarian cysts. Device expulsion rates were low.

Clinical comments

Note

Date of latest search: 07 December 2020

    References

    • Sangkomkamhang US, Lumbiganon P, Pattanittum P. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy). Cochrane Database Syst Rev 2020;(11):CD008994.[PubMed]
    • Jiang W, Shen Q, Chen M et al. Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma: a systematic review. Steroids 2014;86():69-78. [PubMed]

Primary/Secondary Keywords