Levonorgestrel-releasing Intrauterine System VS Oral Progestins For Endometrial Hyperplasia Without Atypical:A Meta-analysis

ObjectiveTo evaluate the therapeutic efficacy of levonorgestrel-releasing intrauterine system(LNG-IUS)with oral progestins for treatment of endometrial hyperplasia without atypical.MethodSearches were conducted on Pub Med database,China How Net(CNKI),Wanfang database,VIP database(VIP),CBMdisc(China biomedical database),and reference lists of relevant articles were screened.Strict inclusion criteria and exclusion criteria,literature screening,according to the Cochrane collaboration bias risk assessment tool to evaluate the quality of the selected literatures,extracted data,and provides the application of the Cochrane collaboration Review Manager 5.3software Meta analysis of the relevant data.ResultsAccording to the inclusion and exclusion criteria of the study,11 articles were included in this study,including English literature in 7 and Chinese literature in 4.Meta analysis showed that LNG-IUS achieved a highly significant therapeutic response rate compared with oral progestins after 3 months of treatment(OR=2.53,95%CI:[1.56,4.12],P=0.0002,7trials,I~2=0%,n=484),after 6 months of treatment(OR=4.07,95%CI:[2.16,7.67],P<0.0001,5trials,I~2=0%,n=433),after 12 months of treatment(OR=8.73,95%CI:[4.48,16.99],P<0.00001,3trials,I~2=53%,n=304),and after 24 months of treatment(OR=7.46,95%CI[2.55,21.78],P=0.0002,1trial,n=104).Subgroup analysis showed evidence of highly significant therapeutic response following LNG-IUS compared with oral progestins for non-atypical simple as well as complex EH(OR=2.68,95%CI:[1.25,5.73],P=0.01,7trisls,I~2= 0%,n=340;and OR=4.30,95%CI:[2.23,8.29],P <0.0001,5,I~2= 0%,n=339,respectively).Compared with oral progestins,LNG-IUS achieved significantly fewerhysterectomies(OR=0.27,95%CI:[0.16,0.45],P<0.00001,3,I~2=0%,n=324).No difference was observed in the rate of irregular vaginal bleeding between both groups(OR=2.23,95%CI:[0.50,9.89],P=0.29,4,I~2=79%,n=270).ConclusionLNG-IUS compared with the oral progesterone treatment of endometrial hyperplasia wiithout atypical has remarkable curative effect,increased endometrial reverse rate,and reduce the rate of hysterectomy,LNG-IUS can be used as the treatment of non atypical endometrial hyperplasia is a safe,effective,suitable for different groups of treatment.