Keywords
Levonorgestrel
Adenomyosis
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Abstract
Objective: To investigate in the scientific literature the treatment for adenomyosis with the Levonorgestrel Intrauterine Device (LNG-IUD). Methods: This is an integrative review of the literature, with articles published between 2019 and 2024, in Portuguese and English. The search for articles was carried out considering the descriptors “Intrauterine Devices”, “Levonorgestrel” and “Adenomyosis”, using the Boolean operator “AND”, in the National Library of Medicine (PubMed), Science Direct and Google Scholar databases. Results: Thirteen articles were selected from 5,002 initially found. Of these, 11 confirmed the efficacy of the LNG-IUD in the treatment of adenomyosis, with improvement of symptoms and reduction of uterine volume. Four studies reported expulsion of the device in large uteruses, but modifications in insertion, such as suture fixation, reduced this problem and improved results. Only one study demonstrated greater efficacy of Dienogest compared to the LNG-IUD. Conclusion: It is concluded that the levonorgestrel IUD is effective in reducing pelvic pain and metrorrhagia, common symptoms of adenomyosis, and in reducing uterine volume with few hormonal effects. It is an efficient and less invasive alternative to control symptoms without resorting to hysterectomy.
References
ARKHIGBE RE, et al. Comparison of the effectiveness of levonorgestrel intrauterine system and dienogest in the management of adenomyosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024; 300: 230-239.
BANU J, et al. Clinical Efficacy of Levonorgestrel Releasing Intrauterine System versus Dienogest for Women having Symptomatic Adenomyosis. Sch Int J Obstet Gynec 2023; 6(1): 34-40.
CHEN S, et al. Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study. Ann Transl Med. 2020; 8(21): 1356.
COSTANZI F, et al. The treatment with Levonorgestrel Releasing Intrauterine System (LNG-IUS) in patients affected by menometrorrhagia, dysmenorrhea and adenomyosis: clinical and ultrasonographic reports. Eur Rev Med Pharmacol Sci. 2021; 25(9): 3432-3439.
GUO W, et al. Compare the Efficacy of Dienogest and the Levonorgestrel Intrauterine System in Women with Adenomyosis 2023; 45(10): 973-976.
ISHIZAWAC, et al. Levonorgestrel-Releasing Intrauterine System Improves Menorrhagia-Related Quality of Life in Patients with Symptomatic Adenomyosis. Reprod Sci. 2023; 30(3): 966-973.
JAISWAL A, et al. Effectiveness and Safety of Levonorgestrel Intrauterine Device in Abnormal Uterine Bleeding, Adenomyosis and Perimenopausal Bleeding Patients. Int. J. Pharm. Investigation, 2024; 14(1):186-190.
KHAN KN, et al. Biological differences between focal and diffuse adenomyosis and response to hormonal treatment. Reprod Biomed Online 2019; 38: 634-46.
KISHI Y, et al. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 2012; 207: 114.e1-7.
KITAWAKI J, et al. Bleeding patterns of women with heavy menstrual bleeding or dysmenorrhoea using the levonorgestrel-releasing intrauterine system: results from a real-world observational study in Japan (J-MIRAI). Eur J Contracept Reprod Health Care. 2022; 27(4): 300-307.
LEE KH, et al. Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis. Arch Gynecol Obstet. 2016; 294(3): 561-6.
LI L, et al. Treatment of symptomatic adenomyosis with the levonorgestrel-releasing intrauterine system. Int J Gynaecol Obstet. 2019; 146(3): 357-363.
LV N, et al. Feasibility and Effectiveness of Hysteroscopic Suture Fixation of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis. J Minim Invasive Gynecol. 2024; 31(1): 57-63.
MAO M, et al. The suture fixation of the levonorgestrel-releasing intrauterine device with hysteroscope for the treatment of adenomyosis in patients at high risk of device expulsion-a prospective observational study. BMC Womens Health. 2024; 24(1): 556.
MAGALHAES J, et al. Uterine volume, menstrual patterns, and contraceptive outcomes in users of the levonorgestrel-releasing intrauterine system: A cohort study with a five-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2022; 276: 56-62.
MOAWAD G, et al. The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review. J Clin Med. 2023; 12(19): 6130.
PARK DS, et al. Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic adenomyosis. Taiwan J Obstet Gynecol. 2015; 54(4): 412-5.
RATHINAM KK, et al. Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review. Eur J Clin Pharmacol. 2022; 78(4): 531-545.
SCHRAGER S, et al. Adenomyosis: Diagnosis and Management. Am Fam Physician, 2022; 105(1): 33-38.
SHENG J, et al. 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.
SONG SY, et al. Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis. Medicine (Baltimore). 2020; 99(22): e20421.
YANG H, et al. Effect of modified levonorgestrel-releasing intrauterine system in human adenomyosis with heavy menstrual bleeding. J Obstet Gynaecol Res. 2022; 48(1): 161-168.
ZHANG H, et al. An innovative surgical approach: suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis. BMC Womens Health. 2022; 22(1): 451.
ZHANG L, et al. Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis. Medical Sciences. 2019; 48(2): 130-135
ZHU GG, et al. CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications. Abdom Radiol (NY). 2024; 49(1): 237-248.