Effects of the levonorgestrel-releasing intrauterine system on urinary symptoms in patients with adenomyosis

Ekin, Murat; Cengiz, Hüseyin; Ayağ, Mehmet Emin; Kaya, Cihan; Yaşar, Levent; Savan, Kadir

doi:10.1016/j.ejogrb.2013.07.019

Cited by 20 publications

(11 citation statements)

References 19 publications

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“…The second trial compared the effect of LNG‐IUS vs hysterectomy on 86 women . The rest of the included studies were either single‐arm trials or prospective observational studies . The diagnosis of adenomyosis was based on clinical suspicion in three included studies, while imaging confirmation of adenomyosis diagnosis was done in the rest.…”

Section: Resultsmentioning

confidence: 99%

“…Along with its contraceptive properties, LNG‐IUS is reported to have non‐contraceptive health benefits for many gynecological conditions such as heavy menstrual bleeding, endometrial hyperplasia and coagulopathies . Over the past two decades, a growing body of evidence has reported a beneficial role of LNG‐IUS in the management of adenomyosis . Nevertheless, there is a scarcity in the published evidence regarding the efficacy of LNG‐IUS in adenomyosis setting .…”

Section: Introductionmentioning

confidence: 99%

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The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

Abbas

Samy

Atwa

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: The levonorgestrel intrauterine system (LNG-IUS) is a long-acting hormone-releasing uterine device that has many non-contraceptive benefits. The study aims to assess the safety and efficacy of LNG-IUS in the management of adenomyosis. Material and methods:We searched the following bibliographic databases: MEDLINE via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Google Scholar for the relevant studies which used LNG-IUS in management of patients with clinically or ultrasonographic diagnosed adenomyosis.The main outcome measures are pain score at the end of follow-up, bleeding, symptomatic relief, uterine volume (mL), endometrial thickness (mm) and/or hemoglobin level.Results: Ten prospective studies (patients n = 551) were included. The overall effect estimates showed that the LNG-IUS led to significant reductions in pain score after 12 months (standardized mean difference [SMD[ −3.87, 95% confidence interval [CI] −5.51 to −2.23, P < .001), 24 months (SMD −5.56, 95% CI −9.80 to −1.32, P = .01) and 36 months of insertion (SMD −3.81, 95% CI −4.27 to −3.36, P < .001). Similarly, the Pictorial Blood Assessment Chart (PBAC) showed significant reduction up to 36 months after LNG-IUS insertion (SMD −2.32, 95% CI −2.91 to −1.73, P < .001).The LNG-IUS led to significant reductions in the uterine volume 12 months (SMD −.60, 95% CI −0.88 to −.31, P < .001) and 36 months after insertion (SMD −0.42, 95% CI −0.69 to −0.14, P = .003). Conclusions:LNG-IUS is a promising and effective option for the management of adenomyosis. Its use effectively reduced the severity of symptoms, uterine volume and endometrial thickness, and improved laboratory outcomes. K E Y W O R D Sadenomyosis, hormonal intrauterine device, levonorgestrel intrauterine system, pain relief

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

Abbas

Samy

Atwa

et al. 2020

Acta Obstet Gynecol Scand

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“…aberrations in sex steroid hormone receptors and function, impaired apoptosis, and increased inflammation. The levonorgestrel intrauterine device (Lng-IUD) contributes to the reduction of pain, menorrhagia, urinary symptoms, and dyspareunia, and reduces the uterine volume and JZ thickness in women with adenomyosis (111)(112)(113)(114). The effect of levonorgestrel is through shrinkage of adenomyotic lesions caused by downregulation of estrogen receptors, preventing further stimulation by estrogens (115).…”

Section: Medical Treatmentmentioning

confidence: 99%

Development of a clinical prediction model for diagnosing adenomyosis

Tellum

Nygaard

Skovholt

et al. 2018

Fertility and Sterility

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“…We included 38 trials, reporting on data from 5175 women ( Table I ) ( Fedele et al , 1997 ; Maia et al , 2003 ; Hadisaputra and Anggraeni, 2006 ; Bragheto et al , 2007 ; Kim et al , 2007 ; Cho et al , 2008 ; Kang et al , 2009 ; Sheng et al , 2009 ; Kang et al , 2010 ; Ozdegirmenci et al , 2011 ; Zhou et al , 2011 ; Kelekci et al , 2012 ; Ekin et al , 2013 ; Liu et al , 2014 ; Zhang et al , 2014 ; Huang et al , 2015 ; Lee et al , 2015 , 2019 ; Long et al , 2015 ; Chong et al , 2016 ; Liu et al , 2016 ; Park et al , 2016 ; Hai et al , 2017 ; Huang et al , 2017 ; Liu et al , 2017 ; Osuga et al , 2017 ; Yang et al , 2017 , 2019 ; Alizzi, 2018 ; Guo et al , 2018 ; Jun-Min et al , 2018 ; Li et al , 2018 , 2020 ; Huang et al , 2020 ; Lin et al , 2020 ; Sun et al , 2020 ; Kwack et al , 2021 ; Sun et al , 2021 ). There were six (16%) randomized controlled trials (RCTs) ( Hadisaputra and Anggraeni, 2006 ; Kang et al , 2010 ; Ozdegirmenci et al , 2011 ; Zhang ...…”

Section: Resultsmentioning

confidence: 99%

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

Tellum

Omtvedt

Naftalin

et al. 2021

Human Reproduction Open

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STUDY QUESTION Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis? SUMMARY ANSWER We identified 38 studies, reporting on 203 outcomes using 133 outcome measures. WHAT IS KNOWN ALREADY Heterogeneity in outcome evaluation and reporting has been demonstrated for several gynaecological conditions and in fertility studies. In adenomyosis, previous systematic reviews have failed to perform a quantitative analysis for central outcomes, due to variations in outcome reporting and measuring. STUDY DESIGN, SIZE, DURATION A systematic search of Embase, Medline and Cochrane Register of Controlled Trials (CENTRAL) was performed with a timeframe from 1950 until February 2021, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). PARTICIPANTS/MATERIALS, SETTING, METHODS Studies reporting on any uterus-sparing intervention to treat adenomyosis, both prospective and retrospective, were eligible for inclusion. Inclusion criteria were a clear definition of diagnostic criteria for adenomyosis and the modality used to make the diagnosis, a clear description of the intervention, a follow up time of ≥ 6 months, a study population of n ≥ 20, a follow up rate of at least 80%, and English language. The population included premenopausal women with adenomyosis. Risk of bias was assessed using the Evidence Project risk of bias tool. MAIN RESULTS AND THE ROLE OF CHANCE We included 38 studies (6 randomized controlled trials and 32 cohort studies), including 5175 participants with adenomyosis. The studies described 10 interventions and reported on 203 outcomes, including 43 classified as harms, in 29 predefined domains. Dysmenorrhea (reported in 82%), heavy menstrual bleeding (HMB) (in 79%) and uterine volume (in 71%) were the most common outcomes. Fourteen different outcome measures were used for dysmenorrhea and 17 for HMB. Quality of life was reported in 9 (24%) studies, patient satisfaction with treatment in 1 (3%). A clear primary outcome was stated in only 18%. LIMITATIONS, REASONS FOR CAUTION This review includes studies with a high risk of bias. WIDER IMPLICATIONS OF THE FINDINGS Shortcomings in the definition and choice of outcomes and outcome measures limit the value of the conducted research. The development and implementation of a core outcome set (COS) for interventional studies in adenomyosis could improve research quality. This review suggests a lack of patient centred research in adenomyosis and people with adenomyosis should be involved in the development and implementation of the COS. STUDY FUNDING/COMPETING INTEREST(S) No funds specifically for this work was received. TT receives fees from General Electrics for lectures on ultrasound independently of this project. TRIAL REGISTRATION NUMBER This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020177466) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative (registration number 1649).

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Effects of the levonorgestrel-releasing intrauterine system on urinary symptoms in patients with adenomyosis

Cited by 20 publications

References 19 publications

The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

Development of a clinical prediction model for diagnosing adenomyosis

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

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