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Elassall GM, Sayed EG, Abdallah NA, El-Zohiry MM, Radwan AA, AlMahdy AM, Sedik AS, Elazeem HASA, Shazly SA. Levonorgestrel-releasing intrauterine system versus systemic progestins in management of endometrial hyperplasia: A systemic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51:102432. [PMID: 35760334 DOI: 10.1016/j.jogoh.2022.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Endometrial hyperplasia is associated with varying risk of endometrial cancer. The aim of this review is to assess effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS), compared to systemic progestins, in management of endometrial hyperplasia MATERIALS AND METHODS: A search on studies comparing LNG-IUS to systemic progestins was conducted on Scopus, Web of science, Cochrane, PubMed and Embase databases, from the date of inception to September 20th, 2020. Studies were excluded if they were non-comparative, animal studies, review articles, case reports, case series, and conference papers. Primary outcomes include resolution/regression rate, failure rate, and hysterectomy rate. Analysis was pooled using random effect model and was expressed as pooled odds ratios (OR) and 95% confidence interval (CI). Quality assessment was performed using Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) assessment tool. MOGGE Meta-analysis Matrix was used to illustrate multiple subgroup analyses. RESULTS Out of 341 studies retrieved from literature search, 12 were eligible. LNG-IUS yielded significantly higher resolution/regression rate (91.3% vs 68.6%, OR 3.42, 95% CI 1.86-6.30). Failure and hysterectomy rates were significantly lower in LNG-IUS group compared to systemic progestins' group (19.2% vs. 32.3%, OR 0.34, 95% CI 0.20-0.57 and 9.3% vs. 24.1%, OR 0.41, 95% CI 0.29-0.57, respectively). Subgroup analysis of studies including complex hyperplasia only did not show significant difference in resolution/regression rate was not statistically significant. CONCLUSION LNG-IUS is associated with high success rate in management of women with endometrial hyperplasia. However, specific effectiveness of LNG-IUS on more advanced histologic subtypes is less studied.
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Affiliation(s)
- Gena M Elassall
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nada A Abdallah
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mariam M El-Zohiry
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Radwan
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - AlBatool M AlMahdy
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Sedik
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hossam Aldein S Abd Elazeem
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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