Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Menopause. 2011 Oct;18(10):1060-6. doi: 10.1097/gme.0b013e31821606c5.
The objective of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with those of systemic progestogen in perimenopausal and postmenopausal women taking systemic estrogen therapy (ET).
We searched Medline (August 8, 2009), Embase (August 8, 2009), the Cochrane Central Register of Controlled Trials on the Cochrane Library Issue 3 (2009), the MetaRegister of Controlled Trials, and the reference lists of articles for relevant trials. Randomized controlled studies of LNG-IUS versus systemic progestogen in perimenopausal and postmenopausal women taking ET were included in the review. Two reviewers abstracted the trials independently. Any disagreement was resolved through discussion with the third reviewer. For dichotomous outcomes, a Peto odds ratio was calculated. For continuous outcomes, nonskewed data from valid scales were synthesized using a weighted mean difference or a standardized mean difference.
Six trials with a total of 518 participants were included. The methodological limitation was an attrition bias. In perimenopausal and postmenopausal women taking ET, the incidence of a proliferative endometrium was comparable between the use of systemic progestogen and LNG-IUS, except for sequential medroxyprogesterone acetate, which had a higher incidence of proliferative endometrium. Descriptive data synthesis showed that ET combined with either LNG-IUS or systemic progestogen effectively relieved climacteric symptoms. Vaginal bleeding and spotting were common in the LNG-IUS group for the first 3 to 6 months of use. The discontinuation rate was not different. There was insufficient evidence to draw any conclusions about the other outcomes.
The LNG-IUS was more effective than sequential medroxyprogesterone acetate but was comparable with other systemic progestogen regimens for endometrial protection in perimenopausal and postmenopausal women taking ET.
本研究旨在比较左炔诺孕酮宫内节育系统（LNG-IUS）与全身孕激素在接受全身雌激素治疗（ET）的围绝经期和绝经后妇女中的作用。
我们检索了 Medline（2009 年 8 月 8 日）、Embase（2009 年 8 月 8 日）、Cochrane 图书馆对照试验注册中心（2009 年第 3 期）、MetaRegister of Controlled Trials 和相关文章的参考文献，以寻找关于 LNG-IUS 与全身孕激素在接受 ET 的围绝经期和绝经后妇女中比较的随机对照试验。本综述纳入了 LNG-IUS 与全身孕激素在接受 ET 的围绝经期和绝经后妇女中比较的随机对照试验。两名评审员独立提取试验。任何分歧都通过与第三名评审员讨论来解决。对于二项结果，计算了 Peto 比值比。对于连续结果，从有效量表获得的非偏斜数据使用加权均数差或标准化均数差进行综合。
共有 6 项试验，总计 518 名参与者。方法学上的局限性是失访偏倚。在接受 ET 的围绝经期和绝经后妇女中，除了序贯醋酸甲羟孕酮外，全身孕激素和 LNG-IUS 的应用对增生性子宫内膜的发生率相似，序贯醋酸甲羟孕酮的增生性子宫内膜发生率更高。描述性数据综合表明，ET 联合 LNG-IUS 或全身孕激素均可有效缓解绝经期症状。LNG-IUS 组在使用的前 3 至 6 个月，阴道出血和点滴出血常见。停药率无差异。对于其他结果，没有足够的证据得出任何结论。
LNG-IUS 比序贯醋酸甲羟孕酮更有效，但在保护围绝经期和绝经后妇女的子宫内膜方面与其他全身孕激素方案相当。
