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Evidence summaries

Levonorgestrelreleasing Intrauterine System for Endometrial Hyperplasia

Levonorgestrel-releasing intrauterine system is effective for endometrial hyperplasia and appears to be more effective than non-intrauterine progestogens. Level of evidence: "A"

The level of evidence is downgraded by study quality and updraded by large magnitude of effect.

Summary

A Cochrane review [Abstract] 1 included 13 studies with 1657 subjects. The levonorgestrel-intrauterine system (LNG-IUS) improved regression of endometrial hyperplasia (EH) compared with non-intrauterine progestogens at short-term follow-up (up to 6 months) (OR 2.94, 95% CI 2.10 to 4.13; I² = 0%; 10 RCTs, n=1108). This suggests that if regression of EH following treatment with a non-intrauterine progestogen is assumed to be 72%, regression of EH following treatment with LNG-IUS would be between 85% and 92%. Regression of EH was improved by LNG-IUS compared with non-intrauterine progestogens at 12 months (OR 3.80, 95% CI 1.75 to 8.23; 1 RCT, n=138). The LNG-IUS was associated with fewer hysterectomies, fewer withdrawals from treatment due to hormone-related adverse effects, and improved patient satisfaction compared to non-intrauterine progestogens. The LNG-IUS may be associated with more bleeding/spotting and less nausea compared to non-intrauterine progestogens.

Clinical comments

Note

Date of latest search: 2020-10-07

References

  • Mittermeier T, Farrant C, Wise MR. Levonorgestrel-releasing intrauterine system for endometrial hyperplasia. Cochrane Database Syst Rev 2020;(9):CD012658. [PubMed]

Primary/Secondary Keywords