| Background Uterine leiomyoma (fibroid) is the most common benign female pelvic tumor, occurring in as many as 30% of women aged over 35 years. Treatment is required only in the presence of symptoms (menorrhagia, pain, pressure et al.). Surgery for uterine leiomyoma either removes leiomyoma tissue only (myomectomy) or removes the uterus (hysterectomy). Besides, many alternatives to hysterectomy or myomectomy have emerged. The levonorgestrel-releasing intrauterine system (LNG-IUS) (Mirena) was launched as a contraceptive in 1990. There are many other non-contraceptive beneficial effects of LNG-IUS including treating women with idiopathic menorrhagia and providing uterine protection for women receiving estrogen replacement therapy or tamoxifen. There is preliminary evidence that shows LNG-IUS may be therapeutic in women with fibroids, endometriosis, adenomyosis, endometrial hyperplasia, early stage endometrial cancer and dysmenorrhoea and may reduce the risk of pelvic inflammatory disease. Only a few prospective studies have examined use of the LNG-IUS specifically for the treatment of fibroid, which is controversial surrounding this subject.Objective To evaluate the clinical efficacy of levonorgestrel releasing intrauterine system (Mirena) in treatment of uterine leiomyoma.Method Meta-analysis was used to collected all the published studies about the levonorgestrel releasing intrauterine system (Mirena) for the treatment of uterine leiomyoma. We searched PUBMED, MEDLINE, CNKI, Wan fang database and reference lists of articles from 2000 to 2015. Languages were restricted to Chinese and English. Studies were selected, according to strict inclusion and exclusion criteria. All the calculations and statistical tests were done with the RevMan 5.2 software.ResultFive controlled clinical trials including 402 patients were enrolled in this study. The analyses suggest that:1. There was statistically reduction in the uterine volume within 6 months (P=0.005) and 12 months (P=0.004) of LNG-IUS insertion.2. There was no statistical significance in the mean volume of leiomyomas after 6 months of use (p=0.13) and 12 months of use (p=0.06).3. Reduction in MBL (menstrual blood loss) was significant at 6-month follow up(P＜0.001) and 12-month follow up(P＜0.00001).4. Statistically significant increases in hemoglobin values were noted at 6-month follow up(P=0.01), and 12-month folloe up(P<0.0001).Conclusion Use of the LNG-IUS appears to lead to a significant reduction in the uterine volume, the MBL, and a statistically significant increases in hemoglobin values, but no significant reduction in leiomyomas volume. |
