Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: a systematic review and metaanalysis of randomized trials

American Journal of Obstetrics and Gynecology
Hatem Abu HashimMohamed El Rakhawy

Abstract

We sought to evaluate the therapeutic efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS) with oral progestins for treatment of non-atypical endometrial hyperplasia (EH). Searches were conducted on PubMed, SCOPUS, and CENTRAL databases to August 2014, and reference lists of relevant articles were screened. The search was limited to articles conducted on human beings and females. The PRISMA Statement was followed. Seven randomized controlled trials (n = 766 women) were included. Main outcome measures were the therapeutic effect rate (histological response) after 3, 6, 12, and 24 months of treatment; rate of irregular vaginal bleeding; and the hysterectomy rate per woman randomized. The Cochrane Collaboration risk of bias tool was used for quality assessment. Metaanalysis was performed with fixed effects model. LNG-IUS achieved a highly significant therapeutic response rate compared with oral progestins after 3 months of treatment (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.39-3.82; P = .001, 5 trials, I(2) = 0%, n = 376), after 6 months of treatment (OR, 3.16; 95% CI, 1.84-5.45; P < .00001, 4 trials, I(2) = 0%, n = 397), after 12 months of treatment (OR, 5.73; 95% CI, 2.67-12.33; P < .00001, 2 trials, ...Continue Reading

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Citations

Jul 29, 2016·Gynecologic Oncology Research and Practice·Michael Feichtinger, Kenny A Rodriguez-Wallberg
Mar 28, 2018·Climacteric : the Journal of the International Menopause Society·A Gompel
Feb 26, 2016·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·Mi Kyoung KimSoon-Beom Kang
Jun 6, 2019·Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology·Antonio RaffoneFulvio Zullo
Aug 8, 2019·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·O RotenbergP Dar
Jan 27, 2019·Obstetrics and Gynecology·UNKNOWN American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology
Jul 25, 2019·Revista da Associação Médica Brasileira·Paulo César GiraldoJosé Marcos Sanches
Aug 28, 2019·Menopause : the Journal of the North American Menopause Society·Jessica Morgan, Erica K Hinz
Sep 11, 2020·The Cochrane Database of Systematic Reviews·Theresa MittermeierMichelle R Wise
May 14, 2021·Expert Opinion on Pharmacotherapy·Andrea R GenazzaniTommaso Simoncini

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