Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis

Song, Soo Youn; Park, Mia; Lee, Geon Woo; Lee, Ki Hwan; Chang, Ha Kyun; Kwak, Sang Mi; Yoo, Heon Jong

doi:10.1016/j.ejogrb.2018.10.014

Cited by 15 publications

(12 citation statements)

References 33 publications

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“…In addition to the above mentioned studies, other reports including randomized controlled trials have demonstrated that post-operative medical treatment markedly reduces the recurrence rate of endometrioma [12][13][14][15][16][17] . Therefore, long-term medical treatment to prevent recurrence is routinely recommended 8 .…”

Section: Discussionmentioning

confidence: 95%

The recurrence rate of ovarian endometrioma in women aged 40–49 years and impact of hormonal treatment after conservative surgery

Lee

Min

Won

et al. 2020

Sci Rep

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The aim of this study was to evaluate the rate of and risk factors for recurrence ovarian endometrioma after conservative surgery in patients aged 40–49 years. This retrospective, single-center study included 408 women between January 2008 and November 2018. All patients underwent ovarian cyst enucleation, were pathologically diagnosed with ovarian endometrioma and were followed up for ≥ 6 months. Recurrence was defined as a cystic mass with diameter ≥ 2 cm detected by sonography. Recurrence rate after conservative surgery and risk factor of recurrence were analyzed. The median follow-up duration after surgery was 32.0 ± 25.9 months (range 6–125 months). Ovarian endometrioma recurred in 34 (8.3%) of included women and median time to recurrence was 22.4 ± 18.2 months. The cumulative recurrences rate at 12, 24, 36, and 60 months were 3.7%, 6.7%, 11.1%, and 16.7%, respectively. Recurrence was correlated with multilocular cysts (p = 0.038), previous surgical history of ovarian endometrioma (p = 0.006) and salpingectomy (p = 0.043), but not use or duration of post-operative medication. In multivariate analysis, large cyst size (> 5.5 cm) was only risk factor for recurrence in this age group. Post-operative medication did not reduce disease recurrence rate, and thus may be administered for endometriosis-associated pain rather than to prevent recurrence in patients aged 40–49 years.

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Section: Discussionmentioning

confidence: 95%

The recurrence rate of ovarian endometrioma in women aged 40–49 years and impact of hormonal treatment after conservative surgery

Lee

Min

Won

et al. 2020

Sci Rep

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“…Moreover, a recent meta‐analysis study reported positive effects of postoperative LNG‐IUS in pain relief and recurrence rate among women with endometriosis . A previous meta‐analysis study showed that LNG‐IUS significantly reduced pain scores and bleeding among women with endometriosis .…”

Section: Discussionmentioning

confidence: 98%

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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“…Considering such controversies, a systematic review included seven studies (491 women), concluding that using LNG‐IUD in the postoperative period proved effective for pain control and prevented the recurrence of dysmenorrhea but was not conclusive regarding the recurrence of lesions 25 . Thus, considering this gap in the current literature, a strong point of our study is to add evidence regarding postoperative medication management, especially regarding the use of LNG‐IUD.…”

Section: Discussionmentioning

confidence: 98%

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

Yela

Vitale

Vizotto

et al. 2021

J of Obstet and Gynaecol

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Aim To evaluate the frequency of complications and factors associated with the recurrence of endometriosis in women with deep infiltrating endometriosis (DIE) undergoing surgical treatment. Methods A retrospective observational cohort study with 72 women who underwent surgery and followed up by DIE at the University of Campinas from 2007 to 2017. The variables analyzed were clinical characteristics, use and type of drug treatment before and after surgery, operative time and complications inherent to the procedure, as well as the recurrence of lesions on imaging. Results The mean age of women was 39.7 ± 6.3 years and the mean follow‐up was 4.56 ± 2.60 years. Complications were reported in 16.6% of surgeries and recurrence of lesions in 34.7%. The risk of intraoperative complications was higher in the presence of lesions of the bowel and in those who used intramuscular progestin before surgery. A higher risk of recurrence was observed among those who did not use hormonal treatment or used a levonorgestrel‐releasing intrauterine device (LNG‐IUD) in the postoperative period. Conclusion Women with DIE have a high rate of complications during surgical treatment and a higher risk of recurrence when they did not receive hormonal treatment or when treated with LNG‐IUD after surgery.

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Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis

Cited by 15 publications

References 33 publications

The recurrence rate of ovarian endometrioma in women aged 40–49 years and impact of hormonal treatment after conservative surgery

The recurrence rate of ovarian endometrioma in women aged 40–49 years and impact of hormonal treatment after conservative surgery

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

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

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