evaluation of levonorgestrel-releasing intrauterine system (lng) in the management of uterine adenomyosis: an update systematic review and meta- analysis

Background objective: adenomyosis is a common benign endometrial disease which causes abnormal uterine bleeding in premenopausal women and affects the quality of life.  the definitive treatment is hysterectomy; however, medical treatment is an option for those who wish to preserve fertility. this systematic review aims to assess the efficacy of levonorgestrel-releasing intrauterine device as medical management in women who have adenomyosis.materials methods: we searched pubmed, cochrane and scopus databases from january 2000 to november 2019 for relevant studies containing the use of levonorgestrel-releasing intrauterine device (lng-iud) in managing patients with ultrasonographic diagnosis of adenomyosis. main outcome measures in the study are menstrual blood loss (milliliters), pain score measured in 10 cm-visual analogue scale, and uterine volume.results: pooled results from meta-analysis showed that after lng-iud treatment for adenomyosis, there is significant reduction in dysmenorrhoea, measured using visual analogue scale after 6 months (standardized mean difference (smd): 3.68; cl: 2.11-5.25) , 12 months (smd: 4.23; ci: 2.99-5.48), 24 months (smd: 4.69; ci: 3.40-5.97) and 36 months (smd: 4.01; ci: 3.57-4.45); significant reduction in menstrual bleeding after 6 months (smd: 2.52; ci: 1.15-3.89), 12 months (smd: 3.43; ci: 1.64-5.22) and 24 months (smd: 3.57; ci: 1.88-5.26); significant reduction in uterine volume after 6 months (smd: 0.49; ci: 0.04-0.93), 12 months (smd: 0.80; ci: 0.11-1.48) and 24 months (smd: 0.86; ci: 0.15-1.58).conclusion: lng-ius is an effective method in alleviating the symptoms of adenomyosis.  it is a valuable long-term alternative for the treatment of adenomyosis for young and perimenopausal women in terms of dysmenorrhoea and heavy menstrual bleeding.