Ablation/Resection Vs Levonorgestrel Intrauterine System (LNG-IUS) for Heavy Menstrual Bleeding : A Systematic Review and Meta-Analysis
| Autor: | Florence Valcourt, P.Y. Laberge, Amélie Boutin, Catherine Bergeron, Madeleine Lemyre, Marie-Anne Thériault, Sarah Maheux-Lacroix |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hysterectomy Obstetrics business.industry medicine.medical_treatment Obstetrics and Gynecology Ablation law.invention medicine.anatomical_structure Randomized controlled trial law Relative risk Meta-analysis medicine Endometrial ablation Amenorrhea Uterine cavity medicine.symptom business |
| Zdroj: | Journal of Minimally Invasive Gynecology. 27:S9 |
| ISSN: | 1553-4650 |
| Popis: | Study Objective To compare the efficacy and safety of endometrial ablation/resection with the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and to investigate sources of heterogeneity between studies. Design A systematic review with meta-analysis. Setting We searched the databases MEDLINE, EMBASE, CENTRAL, Web of Science, Biosis and Google Scholar as well as citations and reference lists published up to August 2019. Patients or Participants We included randomized controlled trials published in any language, comparing endometrial ablation/resection to the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and a normal uterine cavity. Thirteen studies were eligible (n=884 women). Interventions Endometrial ablation/resection versus LNG-IUS. Measurements and Main Results No significant differences were observed between endometrial ablation/resection and the LNG-IUS in terms of subsequent hysterectomy (primary outcome, risk ratio (RR)=1.13,95% CI 0.60 to 2.11, p=0.71, I2=14%, 12 studies), satisfaction, quality of life, amenorrhea and treatment failure. Side effects were less common in women treated with endometrial ablation/resection (p 42 years old), although the reduction did not reach statistical significance (RR= 0.51, 95% CI 0.21 to 1.24, p =0.14, I2 =0%, 5 studies).Sensitivity analysis taking into account methodological quality of included studies and type of surgical devices (first and second generation) did not modify the results. Conclusion Endometrial ablation/resection and the LNG-IUS are two excellent treatment options for heavy menstrual bleeding, although younger women probably have a higher risk of eventually requiring hysterectomy following endometrial ablation. |
| Databáze: | OpenAIRE |
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