Clinical Effectiveness Of Mirena Treatment In Heavy Menstrual Bleeding (HMB) Cased By Uterine Leiomyoma:A Meta-analysis

Objective:To assess the clinical effectiveness of Mirena treatment in heavy menstrual bleeding (HMB) cases with uterine leiomyoma. Methods: The following electronic databasesas PubMed(1978-2016.1), EMbase(2003-2016.1), Cochrane Library(issue 1,2016), OVID(2003-2016.1), CBM(2003-2016.1),CNKI(2003-2016.1),Wanfang data(2000-2016.1),FEBM data (1990-2016.1) were searched,and other databases and supplemented by hand searching of relevant journals. Studies were searched about the clinical effectiveness of Mire-na treatment in heavy menstrual bleeding (HMB) cased by uterine leiomyoma.According to the inclusion and exclusion criteria,two reviewers independently screened studies, extracted data,and evaluated the methodological quality.The meta-analysis was performed using RevMan software version 5.3.Results:Eleven prospective before-after controlled clinical studies involving 630 patients were included. Meta-analyses showed that through the comparison of 12 pros-pective before-and-after itself,follow-up of≥>6months (6 months to 48 months),Compared with before put Mirena, after-put-Mirena can reduce the volume of uterus [SMD=1.59,95% CI (0.78,2.40), P<0.0001], the volume of Uterine fibroids [SMD=0.32,95% CI (0.14,0.50), P< 0.00001], the thickness of the endometrium[SMD=5.11,95% CI (2.45,7.77), P<0.00001],menstrual blood loss [SMD=4.69,95% CI (3.07,6.30), P< 0.00001],the differences were statistically significant,after-put-Mirena hemoglobin increased more. [SMD=-5.28,95% CI (-7.02,-3.54), P< 0.00001],the difference was statistically significant.Conclusion:Uterine fibroids in a single diameter greater than 2.5 cm (multiple myoma measuring the largest fibroids is greater than 1.5 cm in diameter),uterine volume is less than 12 weeks of pregnancy,the uterus morphological rules and require the conservative treatment of patients,Mirena treat of uterus fibroids menorrhagia can reduce menstrual bleeding,hemoglobin increased sign-ificantly more.Mirena Can-reduce the volume of uterus and uterine fibroid.Therefore,strict control the uterine cavity placed Mirena’s indications,Mirena treatment of uterine fibroids menorrhagia is safe and feasible. However,given the low methodological quality and limited sample size of most included studies, this conclusion still needs to be further proved by conducting more strictlydesigned,high-quality and large scale RCT.