Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2012 Jan;91(1):3-9. doi: 10.1111/j.1600-0412.2011.01303.x. Epub 2011 Nov 9.
The levonorgestrel intrauterine system (LNG-IUS), originally designed for long-term contraceptive use, has been on the Scandinavian market for approximately 20 years. Novel clinical indications for the LNG-IUS, derived mainly from investigator-initiated studies, are emerging. These include heavy menstrual bleeding associated with uterine fibroids, endometriosis, adenomyosis, as well as endometrial hyperplasia. In both cohort and randomized studies, the LNG-IUS is effective in decreasing heavy menstrual bleeding, also in women diagnosed with uterine fibroids. In randomized studies the LNG-IUS has shown comparable clinical efficacy to GnRH analogues or progestins for the symptomatic treatment of endometriosis. Experience with LNG-IUS in adenomyosis is based on prospective cohort studies. Dysmenorrhea has been reported to decrease in all women, and uterine volume was seen to diminish in some of these studies. In the treatment of endometrial hyperplasias, including atypical hyperplasia, the LNG-IUS is equal or superior to treatment with systemic progestins. Further studies are needed to examine the full potential of the LNG-IUS in such common clinical situations.
左炔诺孕酮宫内节育系统（LNG-IUS）最初设计用于长期避孕，在斯堪的纳维亚市场已经有大约 20 年的历史。源自于研究者发起的研究，LNG-IUS 的新的临床适应证正在不断涌现。这些适应证包括与子宫肌瘤、子宫内膜异位症、子宫腺肌病以及子宫内膜增生相关的月经过多。在队列研究和随机研究中，LNG-IUS 均能有效减少月经过多，在诊断为子宫肌瘤的女性中也同样有效。在随机研究中，LNG-IUS 在治疗子宫内膜异位症的症状方面与 GnRH 类似物或孕激素具有相当的临床疗效。关于 LNG-IUS 在子宫腺肌病中的应用经验基于前瞻性队列研究。所有女性的痛经均有缓解，在一些研究中观察到子宫体积缩小。在子宫内膜增生症（包括不典型增生）的治疗中，LNG-IUS 与全身孕激素治疗效果相当或更优。需要进一步的研究来评估 LNG-IUS 在这些常见临床情况下的全部潜力。
