Academic Unit of Obstetrics & Gynaecology, University of Manchester School of Cancer, St Mary's Hospital, Manchester, UK.
Climacteric. 2011 Dec;14(6):622-32. doi: 10.3109/13697137.2011.579650. Epub 2011 Oct 23.
Oral progestogens are commonly used for endometrial protection in women at higher risk of developing endometrial abnormality. Long-term intrauterine progestogens may offer an attractive alternative to oral therapy.
To review the evidence regarding the efficacy of intrauterine levonorgestrel-releasing systems (LNG-IUS) in preventing endometrial pathology in high-risk women.
Searches were made of the Cochrane Central Register of Controlled Trials, UK National Research Register (NRR) Archive, Current Controlled Trials, MEDLINE, EMBASE and CINAHL. The selection criteria were randomized, controlled trials (RCTs) comparing LNG-IUS with no treatment, placebo or other hormonal therapy in adult females. Where no RCTs were available, prospective cohort studies were analyzed. Data was extracted using a standardized data collection form. Meta-analysis was performed using RevMan software.
There were six RCTs that investigated LNG-IUS in women using estrogen replacement therapy (ERT). LNG-IUS was at least as effective as other routes of progestogen administration. Only two studies investigated LNG-IUS as treatment for endometrial hyperplasia. Hyperplasia without atypia regressed in all women treated with LNG-IUS. In three studies of LNG-IUS in tamoxifen users, LNG-IUS was associated with reduced risk of endometrial polyps (Peto odds ratio (OR) 0.28; 95% confidence interval (CI) 0.15-0.55) and hyperplasia (Peto OR 0.14; 95% CI 0.02-0.80).
LNG-IUS counters endometrial proliferation and causes regression of and prevents endometrial hyperplasia in selected groups of women. There is, however, insufficient evidence to recommend LNG-IUS as the treatment of choice for hyperplasia and no evidence to adequately support its use as chemoprevention in women with hereditary non-polyposis colorectal cancer syndrome or obesity.
口服孕激素常用于预防子宫内膜异常风险较高的女性发生子宫内膜病变。宫内孕激素长期应用可能是一种较有吸引力的口服治疗替代方案。
系统评价宫内左炔诺孕酮释放系统（LNG-IUS）预防高危女性子宫内膜病变的疗效。
检索 Cochrane 对照试验中心注册库、英国国家研究注册库（NRR）档案、当前对照试验、MEDLINE、EMBASE 和 CINAHL。纳入标准为比较 LNG-IUS 与无治疗、安慰剂或其他激素治疗的随机对照试验（RCT），研究对象为成年女性。若无 RCT 可用，则分析前瞻性队列研究。使用标准化数据采集表提取资料。采用 RevMan 软件进行荟萃分析。
共有 6 项 RCT 研究了雌激素替代治疗（ERT）中 LNG-IUS 的应用。LNG-IUS 的疗效至少与其他孕激素给药途径相当。仅有 2 项研究将 LNG-IUS 用于治疗子宫内膜增生。所有接受 LNG-IUS 治疗的患者增生均无不典型性而消退。在 3 项 LNG-IUS 用于三苯氧胺使用者的研究中，LNG-IUS 与子宫内膜息肉风险降低相关（Peto 比值比（OR）0.28；95%置信区间（CI）0.15-0.55）和增生（Peto OR 0.14；95% CI 0.02-0.80）。
LNG-IUS 可拮抗子宫内膜增殖，使子宫内膜增生消退，并预防子宫内膜增生。然而，目前尚无足够证据推荐 LNG-IUS 作为子宫内膜增生的首选治疗方法，也无证据充分支持其用于遗传性非息肉病结直肠癌综合征或肥胖女性的化学预防。
