Nova Sure Impedance Control Endometrial Resectin And Levonorgestrel-releasing Intrauterine System In The Treatment Of Heavy Menstrual Bleeding:A Meta-analysis

background:Massive menstrual bleeding can affect a woman’s physical and mental health,and two common treatments are second-generation endometrial removal(NovaSure)and levonorgestrel intrauterine sustained release system(LNG-IUS/Mirena),which avoid the use of relatively invasive hysterectomy.At present,there is a lack of prospective clinical studies of NovaSure impedance control endometrial resection system and Mirena treating large samples of menorrhagia,and there is no evidence-based recommendation on the treatment of these two menorrhagia methods,so directly comparing the efficacy and complications of these two surgical methods is crucial for the rational choice of treatment.Objective:The purpose of this analysis is used to evaluate and compare the efficacy of the second-generation endometrial ablation(NovaSure)with the levonorgestrel intrauterine extended-release system(Mirena)in the treatment of moderate and severe menstrual bleeding.Methods:By searching electronic databases at home and abroad,including PubMed,Web of Science,Medline,Cochrane Library,CNKI,WanFang,CBM databases,using Google,Baidu Academic Browser and "Related Articles" function to find relevant literature,the time limit is from January 2010 to January 2022,the literature of clinical experimental and observational studies comparing the NovaSure impedance endometrial resection system with Mirena’s treatment of Heavy Menstrual Bleeding.Strict screening,collation of data and statistical analysis with RevMan5.3 software to draw conclusions.Results:After intensive reading,7 articles were included,Chinese six and one in English,and 7 randomized controlled trials,A total of 836 patients were included,including 418 cases in the NovaSure group and 418 cases in the Mirena group.The meta-analysis results showed that:The postoperative efficiency in the NovaSure group than in the Mirena group in the treatment of HMB[OR=3.01,95%CI(1.56,5.83),P=0.001]comparison,NovaSure group was higher than the Mirena group.The incidence of postoperative menopause in the NovaSure group than in the Mirena group in the treatment of HMB[OR=3.89,95%CI(1.82,8.33),P=0.0005]comparison;Analysis of postoperative satisfaction rates between the two groups[OR=2.87,95%CI(1.65,4.98),P=0.0002],After surgery the level of postoperative satisfaction the NovaSure group was higher in the treatment of HMB than in the Mirena group;Comparing the postoperative complication rates[OR=0.43,95%CI(0.26,0.69),P=0.0006],the NovaSure group had fewer postoperative complications than the Mirena group;After surgery the level of HB in the NovaSure group was lower in the treatment of HMB than in the Mirena group[MD=39.6,95%CI(36.45,42.75),P<0.00001]at 3 months,NovaSure group had higher HB levels in the 3 months after surgery than in the Mirena group;Hemoglobin levels in the NovaSure group and the Mirena group at 6 months after surgery[MD=22.21,95%CI(4.92,39.49),P=0.01],NovaSure group had higher HB levels in the 6 months after surgery than in the Mirena group,Hemoglobin levels in the NovaSure group and the Mirena group at 12 months after surgery[MD=11.73,95%CI(10.22,13.24),P<0.00001]comparison:After surgery the level of HB in the NovaSure group was lower in the treatment of HMB than in the Mirena group at 12 months.Analysis of postoperative PBAC levels between the two groups[MD=-19.96,95%CI(-21.11,-18.81),P<0.00001]Comparison:After surgery the level of PBLAC in the NovaSure group was lower in the treatment of HMB than in the Mirena group.After surgery the level of endometrial thickness in the NovaSure group than in the Mirena group in the treatment of HMB[MD=-0.65,95%CI(-1.26,-0.05),P=0.03]Comparison:The difference between the postoperative endometrial thickness levels in the NovaSure group and the Mirena group was statistically significant.Conclusion:In this paper,through a meta-analysis of the data of NovaSure controlled endometrial resection system and levonorgestrel intrauterine sustained release system for the treatment of Heavy Menstrual Bleeding,the results show that the NovaSure group has better efficacy in treating HMB and has fewer complications,mainly manifested in:1.After surgery the effectiveness level in the NovaSure group was higher than in the Mirena group in the treatment of HMB;2.In the treatment of HMB the postoperative NovaSure group had a higher amenorrhea level than the Mirena group;3.The postoperative satisfaction rate of the research group was higher than that of the control group;4.After surgery the level of complications in the NovaSure group was lower in the treatment of HMB than in the Mirena group;5.After surgery the level of HB in the NovaSure group was lower in the treatment of HMB than in the Mirena group;6.After surgery the level of PBLAC in the NovaSure group was lower in the treatment of HMB than in the Mirena group;7.After surgery the level of endometrial thickness in the NovaSure group was lower in the treatment of HMB than in the Mirena group.Excluding cost factors,NovaSure is a better choice for treating HMB in patients without fertility requirements,but the clinical efficacy and complications of NovaSure still need to be further demonstrated by the design of a prospective clinical study protocol with a larger sample and long-term follow-up.