Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis.

Abstract

OBJECTIVE:

To conduct a systematic review and metaanalysis of studies evaluating the regression rate of endometrial hyperplasia with oral progestogens and levonorgestrel-releasing intrauterine system.

STUDY DESIGN:

Searches were conducted on Medline, Embase, Cochrane Library, and Web of Science, and reference lists of relevant articles were examined. The methodologic index for nonrandomized studies was used for quality assessment. Metaanalysis was performed with random effects model.

RESULTS:

There were 24 observational studies (1001 women), of low methodologic quality, evaluating the outcome of regression of endometrial hyperplasia with oral progestogens or levonorgestrel-releasing intrauterine system. Metaanalysis showed that oral progestogens achieved a lower pooled regression rate compared with levonorgestrel-releasing intrauterine system for complex (pooled rate, 66% vs 92%; P < .01) and atypical hyperplasia (pooled rate, 69% vs 90%; P = .03). There was no statistical difference in simple hyperplasia (pooled rate, 89% vs 96%; P = .41).

CONCLUSION:

Oral progestogens appear to induce a lower disease regression rate than Levonorgestrel-releasing intrauterine system in the treatment of endometrial hyperplasia.

• Authors: Ioannis D Gallos, Manjeet Shehmar, Shakila Thangaratinam, Thalis K Papapostolou, Arri Coomarasamy, Janesh K Gupta
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 203 Issue 6 Pg. 547.e1-10 (Dec 2010) ISSN: 1097-6868 [Electronic] United States
• PMID: 20934679 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2010 Mosby, Inc. All rights reserved.

Chemical References

• Contraceptives, Oral, Synthetic
• Progestins
• Levonorgestrel

Topics

• Administration, Oral
• Cohort Studies
• Contraceptives, Oral, Synthetic (administration & dosage)
• Controlled Clinical Trials as Topic
• Endometrial Hyperplasia (drug therapy, pathology)
• Female
• Follow-Up Studies
• Humans
• Intrauterine Devices, Medicated
• Levonorgestrel (administration & dosage, adverse effects)
• Precancerous Conditions (drug therapy, pathology)
• Progestins (administration & dosage, adverse effects)
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome