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Open Access 11-03-2025 | Levonorgestrel | Gynecologic Endocrinology and Reproductive Medicine

Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis

Authors: Juliana Almeida Oliveira, Gabriel Lage Neves, Matheus Eduardo Soares Pinhati, Flávia Ribeiro de Oliveira, Agnaldo Lopes da Silva Filho

Published in: Archives of Gynecology and Obstetrics

Abstract

Purpose

We aimed to conduct a systematic review and meta-analysis comparing the outcomes of subdermal implants and levonorgestrel intrauterine system (LNG-IUS) in reproductive-aged women.

Methods

In April 2024, we searched Pubmed, Embase and Cochrane trials using the search terms: “etonogestrel”, “levonorgestrel” and “randomized controlled trials”. We identified 2862 results comparing the LNG-IUS to subdermal implants. Randomized controlled trials (RCTs) were selected with no restrictions on language or year of publication.

Results

We include six RCTs comprising 1503 patients. R Studio was used for statistical analysis. Subdermal implants were associated with a higher risk of dissatisfaction (OR 2.42; 95% CI 1.47–3.98), acne (OR 2.21; 95% CI 1.21–4.04), weight gain (OR 4.63; 95% CI 1.96–10.63), and device removal due to side effects (OR 2.02; 95% CI 1.20–3.41) compared to the LNG-IUS group. Subgroup analysis indicated that irregular bleeding may be influenced by gynecological conditions, and the risk of new ovarian cyst detection was lower in healthy women using subdermal implants. Norplant-2 was associated with an increased risk of irregular bleeding and a decreased risk of amenorrhea or infrequent bleeding. The leave-one-out analysis and heterogeneity were well distributed among studies for all evaluated outcomes.

Conclusions

Reproductive-aged women in use of subdermal implants experienced a higher rate of acne, weight gain, device removal due to side effects and dissatisfaction compared to those in use of LNG-IUS.

Trial registration

PROSPERO ID: CRD42024516472.

Available only for authorised users

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Title: Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis
Authors: Juliana Almeida Oliveira
Gabriel Lage Neves
Matheus Eduardo Soares Pinhati
Flávia Ribeiro de Oliveira
Agnaldo Lopes da Silva Filho
Publication date: 11-03-2025
Publisher: Springer Berlin Heidelberg
Keywords: Levonorgestrel
Endometriosis
Acne
Amenorrhoea
Published in: Archives of Gynecology and Obstetrics
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-025-07943-6

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