Levonorgestrel-Releasing Intrauterine System and Endometrial Ablation in Heavy Menstrual Bleeding: A Systematic Review and Meta-Analysis

@article{Kaunitz2009LevonorgestrelReleasingIS,
  title={Levonorgestrel-Releasing Intrauterine System and Endometrial Ablation in Heavy Menstrual Bleeding: A Systematic Review and Meta-Analysis},
  author={Andrew M. Kaunitz and Susanna M Meredith and Pirjo Inki and Ali A Kubba and Luis S{\'a}nchez-Ramos},
  journal={Obstetrics \& Gynecology},
  year={2009},
  volume={113},
  pages={1104-1116}
}
OBJECTIVE: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION: This systematic review and meta… Expand
Levonorgestrel-Releasing Intrauterine System (52 mg) for Idiopathic Heavy Menstrual Bleeding: A Health Technology Assessment.
TLDR
The 52-mg LNG-IUS is an effective and cost-effective treatment option for idiopathic heavy menstrual bleeding and improves quality of life and menstrual blood loss, and is well tolerated compared with endometrial ablation, hysterectomy, or usual medical therapies. Expand
Endometrial ablation or resection versus levonorgestrel intra-uterine system for the treatment of women with heavy menstrual bleeding and a normal uterine cavity: a systematic review with meta-analysis.
TLDR
Endometrial ablation/resection and the LNG-IUS are two excellent treatment options for heavy menstrual bleeding, although women treated with the L gas are at higher risk of experiencing side effects and side effects were less common in women treatment with endometrialAblation/ resection. Expand
Levonorgestrel-Releasing Intrauterine System versus Medical Therapy for Menorrhagia: A Systematic Review and Meta-Analysis
TLDR
The LNG-IUS was the more effective first choice for management of menorrhagia compared with conventional medical treatment and quality of life assessment favored LNG -IUS overventional medical treatment, although use of various measurements limited the ability to pool the data for more powerful evidence. Expand
Bleeding patterns with the levonorgestrel-releasing intrauterine system when used for heavy menstrual bleeding in women without structural pelvic pathology: a pooled analysis of randomized controlled studies.
TLDR
In women with HMB, the LNG-IUS is associated with an initial increase in number of B/S days that improve over time that remain elevated relative to baseline during the first year of treatment. Expand
Levonorgestrel-Releasing Intrauterine System or Medroxyprogesterone for Heavy Menstrual Bleeding: A Randomized Controlled Trial
TLDR
In women with idiopathic heavy menstrual bleeding, the levonorgestrel-releasing intrauterine system reduces menstrual blood loss more effectively and has a higher likelihood of treatment success than oral medroxyprogesterone acetate. Expand
Impact of a new levonorgestrel intrauterine system, Levosert®, on heavy menstrual bleeding: results of a one-year randomised controlled trial
  • M. Mawet, F. Nollevaux, +9 authors J. Foidart
  • Medicine
  • The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception
  • 2014
TLDR
Levosert®, a new LNG-IUS designed to release the same daily amount of LNG as Mirena®, is highly effective in the treatment of HMB. Expand
Original research article Five-year follow-up of levonorgestrel-releasing intrauterine system versus thermal balloon ablation for the treatment of heavy menstrual bleeding: a randomized controlled trial ☆,☆☆
TLDR
Five-year follow-up of HMB treatment with LNG-IUS was associated with higher efficacy and satisfaction ratings compared to TBA, and patient acceptability, perceived clinical improvement and overall satisfaction rates were significantly higher in women using LNG -IUS. Expand
Original research article Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial
TLDR
The LNG-IUS is a more effective therapy for idiopathic menorrhagia compared to COC, and this study compared the efficacy of the levonorgestrel-releasing intrauterine system to low dose combined oral contraceptive pills. Expand
A randomized prospective trial comparing the levonorgestrel-releasing intrauterine system with thermal balloon ablation for the treatment of heavy menstrual bleeding.
TLDR
Both the LNG-IUS and TBA appear to be effective in controlling HMB; however, posttreatment uterine bleeding patterns are different. Expand
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References

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Levonorgestrel‐Releasing Intrauterine Device Versus Hysteroscopic Endometrial Resection in the Treatment of Dysfunctional Uterine Bleeding
TLDR
Somewhat less satisfactory results were obtained with a levonorgestrel-releasing intrauterine system compared with endometrial resection for dysfunctional uterine bleeding at 1 year of follow-up. Expand
Long-Term Treatment of Menorrhagia With Levonorgestrel Intrauterine System Versus Endometrial Resection
TLDR
The high continuation rate suggests that the levonorgestrel intrauterine system is comparable with transcervical resection of the endometrium in the treatment of menorrhagia. Expand
A randomized controlled trial of levonorgestrel releasing IUD and thermal balloon ablation in the treatment of menorrhagia.
TLDR
At one year of follow-up, the medicated device was effective but not as effective in reducing the menstrual blood loss, however it was found to be as effective as thermal balloon ablation in increasing the hemoglobin values. Expand
Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy.
TLDR
The use of the levonorgestrel intrauterine system is a good conservative alternative to hysterectomy in the treatment of menorrhagia and should be considered before hystEREctomy or other invasive treatments. Expand
The Efficacy of Levonorgestrel-Releasing Intrauterine Device in Selected Cases of Myoma-Related Menorrhagia: A Prospective Controlled Trial
TLDR
This prospective controlled trial demonstrates the effectiveness of LNG-IUD in this setting and equivalent results are obtained as compared to TBA. Expand
A randomized controlled trial of hysterectomy or levonorgestrel-releasing intrauterine system in the treatment of menorrhagia-effect on FSH levels and menopausal symptoms.
TLDR
Hysterectomy may impair ovarian function shown by rising serum FSH levels and hot flushes, however, these results should be interpreted with caution, and longer follow-up is needed. Expand
Management of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection
TLDR
The placement of LNG-IUS has a dramatic effect in lowering bleeding intensity in menorrhagic patients, with the advantage of reversibility, and mild adverse events. Expand
Prospective comparison study of levonorgestrel IUD versus Roller-Ball endometrial ablation in the management of refractory recurrent hypermenorrhea.
  • T. Römer
  • Medicine
  • European journal of obstetrics, gynecology, and reproductive biology
  • 2000
TLDR
The insertion of a levonorgestrel IUD for the local hormonal treatment of recurrent hypermenorrhea refractory to oral treatment can be tried before endometrial ablation. Expand
Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up.
TLDR
By providing improvement in HRQL at relatively low cost, the LNG-IUS may offer a wider availability of choices for the patient and may decrease costs due to interventions involving surgery. Expand
Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T.
TLDR
The results suggest that the endometrium recovers quickly, normal ovulations are established and the fertility seems to be unaffected after use of an LNG-IUD. Expand
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