What is the best drug treatment for premenopausal women with bleeding irregularities using the levonorgestrel-releasing intrauterine system? A systematic review

Autor:	R. M. G. Tibosch, Peggy M.A.J. Geomini, P. A. H. H. van der Heijden, L. M. Bullens, Sebastiaan Veersema, B. N. Bui, Marlies Y. Bongers, E. J. L. G. Delvaux
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	endocrine system medicine.medical_specialty Levonorgestrel System a 03 medical and health sciences Drug treatment bleeding irregularities 0302 clinical medicine Naproxen Mirena medicine Humans Pharmacology (medical) Cyclooxygenase Inhibitors 030212 general & internal medicine Adverse effect Menorrhagia 030219 obstetrics & reproductive medicine Estradiol treatment Obstetrics business.industry Intrauterine Devices Medicated Obstetrics and Gynecology Estrogens Discontinuation Reproductive Medicine Contraceptive Agents Hormonal Premenopause LNG-IUS Female business medicine.drug discontinuation
Zdroj:	European Journal of Contraception and Reproductive Health Care. 25(6):484-491
ISSN:	1362-5187
Popis:	Objective Up to 60% of women discontinue using the levonorgestrel-releasing intrauterine system (LNG-IUS) within 5 years because of bleeding irregularities, pain and/or systemic progestogenic adverse effects. The aim of the study was to assess treatment options for bleeding irregularities in women using the 52 mg LNG-IUS. Methods Database searches of Medline, Embase/Ovid and the Cochrane Library were carried out, and journals were searched by hand, for relevant studies published from database inception to March 2020. Inclusion criteria were randomised controlled trials (RCTs), prospective cohort studies and case-control studies of premenopausal women using the LNG-IUS and receiving medical treatment for bleeding irregularities. Screening, data extraction and quality assessment of retrieved articles were carried out independently by two pairs of reviewers. The primary outcome was the reduction of bleeding/spotting days. Results Of the 3061 studies identified, eight met our inclusion criteria: six RCTs and two prospective cohort studies. The eight studies enrolled a total of 677 women who were treated with tamoxifen, mifepristone, ulipristal acetate, naproxen, oestradiol, mefenamic acid, tranexamic acid or the progesterone receptor modulator CDB 2914. The results of our analysis indicated that naproxen may be effective for the prophylactic treatment of bleeding immediately (6 months after insertion (low level of evidence). Conclusion Evidence for the medical treatment of (ongoing) bleeding irregularities during use of the LNG-IUS is lacking and more research is needed on the topic.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5a59e37c6de1d1025cc5ab02aba6a65c https://doi.org/10.1080/13625187.2020.1797663 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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