Levonorgestrel-releasing intrauterine system versus systemic progestins in management of endometrial hyperplasia: A systemic review and meta-analysis.

Autor: Elassall GM; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Sayed EG; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Abdallah NA; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., El-Zohiry MM; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Radwan AA; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., AlMahdy AM; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Sedik AS; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Elazeem HASA; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt., Shazly SA; Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: shazly.sherif2020@gmail.com.
Jazyk: angličtina
Zdroj: Journal of gynecology obstetrics and human reproduction [J Gynecol Obstet Hum Reprod] 2022 Oct; Vol. 51 (8), pp. 102432. Date of Electronic Publication: 2022 Jun 25.
DOI: 10.1016/j.jogoh.2022.102432
Abstrakt: 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 20 th , 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.
Competing Interests: Declaration of Competing Interest None
(Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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