The Role of Levonorgestrel Intra-uterine System in the Management of Adenomyosis: A Systematic Review and Meta-analysis of Prospective Studies

摘要

Adenomyosis is a prevalent disorder characterized by the presence of ectopic endometrial tissues within the myometrium. Its etiology and pathogenesis are unclear. The most debilitating adenomyosis-related symptoms are considered to be dysmenorrhea and nonmenstrual pelvic pain, which are reported to affect more than one third of patients. Women with adenomyosis also present with menorrhagia, dyspareunia and infertility. Previous studies have shown that adenomyosis has a negative impact on daily activities and the quality of life and increases the risk of anxiety, depression, and other psychological disorders. Hysterectomy is the only definitive treatment for adenomyosis, but it is associated with increased risks of bladder injury, persistent pelvic pain, and other perioperative complications. At present, medical treatment is the first-line option for symptomatic relief. Themost commonly prescribed drugs for pain relief are nonsteroidal anti-inflammatory drugs. Other widely used options include gonadotropin-releasing hormone analog, progesterone, androgen derivatives, combined oral contraceptives, and hormonal receptor modulators.