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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2017

01-05-2017 | Gynecologic Oncology

Levonorgestrel-Releasing Intrauterine Systems Versus Oral Cyclic Medroxyprogesterone Acetate in Endometrial Hyperplasia Therapy: A Meta-Analysis

Authors: Jin-Sung Yuk, MD, PhD, Jae Yen Song, MD, PhD, Jung Hun Lee, MD, PhD, Won I. Park, MD, PhD, Hyeong Sik Ahn, MD, PhD, Hyun Jung Kim, MPH, PhD

Published in: Annals of Surgical Oncology | Issue 5/2017

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Abstract

Background

This study aimed to compare the levonorgestrel-releasing intrauterine system (LNG-IUS) with oral cyclic medroxyprogesterone acetate (MPA) in endometrial hyperplasia therapy using randomized controlled trials (RCTs).

Methods

The study searched MEDLINE, EMBASE, CENTRAL, and other databases. All regression outcomes were calculated for dichotomous outcomes in terms of relative risk (RR) and 95% confidence intervals (CIs) using a Mantel–Haenszel random effects model.

Results

The search found 543 articles but selected 342 articles after the removal of duplicates. A meta-analysis found five RCTs (377 patients). The study did not analyze RR for total outcome because of high heterogeneity (I 2 = 87%). In a subgroup analysis of studies with non-obese women, the LNG-IUS treatment appeared to have a higher regression rate than oral MPA (RR 1.41; 95% CI 1.23–1.62; 4 trials, 265 patients; I 2 = 0%). In a subgroup analysis of studies with obese women, LNG-IUS appeared to have a regression rate similar to that of oral MPA (RR 1.03; 95% CI 0.94–1.13; 1 trial, 60 patients). In a subgroup analysis according to histology in the non-obese group, the LNG-IUS treatment appeared to have a higher regression rate than oral cyclic MPA in a meta-analysis of women with non-atypical endometrial hyperplasia (RR 1.36; 95% CI 1.07–1.73; 2 trials, 92 patients; I 2 = 6%) and mixed endometrial hyperplasia (atypical and non-atypical) (RR 1.44; 95% CI 1.21–1.71; 2 trials, 173 patients; I 2 = 0%).

Conclusions

The LNG-IUS treatment has a higher regression rate than cyclic MPA in non-atypical endometrial hyperplasia and mixed endometrial hyperplasia therapy for non-obese women but has a similar regression rate, albeit limited, for obese women.
Appendix
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Metadata
Title
Levonorgestrel-Releasing Intrauterine Systems Versus Oral Cyclic Medroxyprogesterone Acetate in Endometrial Hyperplasia Therapy: A Meta-Analysis
Authors
Jin-Sung Yuk, MD, PhD
Jae Yen Song, MD, PhD
Jung Hun Lee, MD, PhD
Won I. Park, MD, PhD
Hyeong Sik Ahn, MD, PhD
Hyun Jung Kim, MPH, PhD
Publication date
01-05-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5699-9

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