Iranian Society of Gynecology Oncology

Document Type : Meta-Analysis Article


Department of Obstetrics and Gynaecology, International Medical University, Seremban, Malaysia


Background & Objective: Adenomyosis is a common benign endometrial disease which causes abnormal uterine bleeding in premenopausal women and affects the quality of life.  The definitive treatment is hysterectomy; however, medical treatment is an option for those who wish to preserve fertility. This systematic review aims to assess the efficacy of levonorgestrel-releasing intrauterine device as medical management in women who have adenomyosis.
Materials & Methods: We searched PubMed, Cochrane and Scopus databases from January 2000 to November 2019 for relevant studies containing the use of levonorgestrel-releasing intrauterine device (LNG-IUD) in managing patients with ultrasonographic diagnosis of adenomyosis. Main outcome measures in the study are menstrual blood loss (milliliters), pain score measured in 10 cm-visual analogue scale, and uterine volume.
Results: Pooled results from meta-analysis showed that after LNG-IUD treatment for adenomyosis, there is significant reduction in dysmenorrhoea, measured using Visual Analogue Scale after 6 months (Standardized Mean Difference (SMD): 3.68; Cl: 2.11-5.25) , 12 months (SMD: 4.23; CI: 2.99-5.48), 24 months (SMD: 4.69; CI: 3.40-5.97) and 36 months (SMD: 4.01; CI: 3.57-4.45); significant reduction in menstrual bleeding after 6 months (SMD: 2.52; CI: 1.15-3.89), 12 months (SMD: 3.43; CI: 1.64-5.22) and 24 months (SMD: 3.57; CI: 1.88-5.26); significant reduction in uterine volume after 6 months (SMD: 0.49; CI: 0.04-0.93), 12 months (SMD: 0.80; CI: 0.11-1.48) and 24 months (SMD: 0.86; CI: 0.15-1.58).
Conclusion: LNG-IUS is an effective method in alleviating the symptoms of adenomyosis.  It is a valuable long-term alternative for the treatment of adenomyosis for young and perimenopausal women in terms of dysmenorrhoea and heavy menstrual bleeding.


Main Subjects

1. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):547-55. [DOI:10.1016/j.bpobgyn.2006.01.006] [PMID]
2. Garcia L, Isaacson K. Adenomyosis: Review of the Literature. J Minim Invasive Gynecol. 2011;18(4):428-37. [DOI:10.1016/j.jmig.2011.04.004] [PMID]
3. Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018;109(3):406-17. [DOI:10.1016/j.fertnstert.2018.01.032] [PMID]
4. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019;8. [DOI:10.12688/f1000research.17242.1] [PMID] [PMCID]
5. Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-93. [DOI:10.1016/j.contraception.2008.11.004] [PMID]
6. Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):511-21. [DOI:10.1016/j.bpobgyn.2006.01.016] [PMID]
7. Li J-J, Chung JPW, Wang S, Li T-C, Duan H. The investigation and management of adenomyosis in women who wish to improve or preserve fertility. Biomed Res Int. 2018;2018. [DOI:10.1155/2018/6832685] [PMID] [PMCID]
8. Morassutto C, Monasta L, Ricci G, Barbone F, Ronfani L. Incidence and estimated prevalence of endometriosis and adenomyosis in Northeast Italy: a data linkage study. PloS one. 2016;11(4):e0154227. [DOI:10.1371/journal.pone.0154227] [PMID] [PMCID]
9. Yeniel O, Cirpan T, Ulukus M, Ozbal A, Gundem G, Ozsener S, et al. Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clin Exp Obstet Gynecol. 2007;34(3):163-7.
10. Leyendecker G, Herbertz M, Kunz G, Mall G. Endometriosis results from the dislocation of basal endometrium. Hum Reprod. 2002;17(10):2725-36. [DOI:10.1093/humrep/17.10.2725] [PMID]
11. Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-s4. [DOI:10.4103/sja.SJA_543_18] [PMID] [PMCID]
12. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013.
13. Cho S, Nam A, Kim H, Chay D, Park K, Cho DJ, et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am J Obstet Gynecol. 2008;198(4):373.e1-.e7. [DOI:10.1016/j.ajog.2007.10.798] [PMID]
14. Alizzi FJ, Showman HAK, Fawzi HA. Levonorgestrel-releasing intrauterine system in adenomyosis; predictors for response and clinical outcome. Asian J Pharm Clin Res. 2018;11(12):214-7. [DOI:10.22159/ajpcr.2018.v11i12.27109]
15. Li L, Leng J, Jia S, Lang J. Treatment of symptomatic adenomyosis with the levonorgestrel-releasing intrauterine system. Int J Gynaecol Obstet. 2019;146(3):357-63. [DOI:10.1002/ijgo.12887] [PMID]
16. Farquhar C, Brosens I. Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):603-16. [DOI:10.1016/j.bpobgyn.2006.01.012] [PMID]
17. Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):449-63. [DOI:10.1016/j.bpobgyn.2006.01.007] [PMID]
18. Taran FA, Stewart EA, Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd. 2013;73(09):924-31. [DOI:10.1055/s-0033-1350840] [PMID] [PMCID]
19. Tsui K-H, Lee W-L, Chen C-Y, Sheu B-C, Yen M-S, Chang T-C, et al. Medical treatment for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol. 2014;53(4):459-65. [DOI:10.1016/j.tjog.2014.04.024] [PMID]