The Clinical Efficacy Of Mirena For The Treatment Of Menorrhagia:a Meta-Analysis

Objective To evaluate the clinical efficacy of the levonorgestrel releasingintrauteirne system (Mirena) in the treatment of menorrhagia.Materials and method1、Searchstrategy We searched PUBMED，MEDLINE, CNKI，CBM disc，Wan fang database and reference lists of articles. Languages were restricted toChinese and English.2、Selectioncriteira Tirals were included if they were randomized controlledtrials about the levonorgestrel releasing intrauteirne system (Mirena) for the treatmentof menorrhagia.3、Datacollection and analysis Data extraction and quality assessment wasperformed independently by the author. All the calculations and statistical tests weredone with the RevMan5.1software.ResultSixteen tirals involving1335patients were identified and included in this review.Among the16inclusive studies,13were considered as high quality studies and3were considered as low quality studies. The findings suggest that:1. Compared to the traditional oral medicine:(1)The effective rate was higher in the LNG-IUS group than the oral medicinegroup both at6-month follow up(RR=3.77，95%CI=[2.47,5.74],P<0.0000l)and at12-month follow up(RR=1.62,95%CI=[1.26,2.07],P=0.0001<0.05).(2)The failure rate was lower in the LNG-IUS group than the oral medicinegroup at12-month follow up(RR=0.38，95%CI=[0.21,0.68]=，P0.001<0.05).(3)Reduction in MBL was more signiifcant in the LNG-IUS group at3-monthfollow up(RR:50.60，95%CI=[47.62,53.58],P<0.00001) and12-month followup(RR=66.91,95%CI=[42.61,91.20]〈,P0.00001); Reduction in PBAC score wasmore significant in the LNG-IUS group at6-month follow up(RR=31.83,95%CI=[1.07，62.59]，P=0.04<0.05) and at12-month follow up(RR=58.69=，95%CI[10.10， 107.28],P=0.02<0.05).2.Compared to Endometrial ablation:(1)There were no statistical significance in the effective rate bewteen the twogroups at12-month follow up(RR=0.88,95%CI=[0.76,1.03]，P=0.12〉0.05).(2)There were no statistical significance in amenorrhoea rate ewteen the twogroups at12-month follow up(RR=0.81,95%CI=[0.34,1.90]>,P=0.620.05).(3)The failure rate was higher in the LNG-IUS group than the Endometiralablation group at12-month follow up(RR=2.26,95%CI=[1.23,4.17],P=0.009<0.05).(4)There were no statistical significance in PBAC scores between the twogroups at6-month follow up(RR=-19.99，95%CI=[-54.05,14.07,P=0.25>0.05) or at12-month ofllow up(RR=1.75=，95%CI [-39.58,43,08]，P二0.93〉0.05).(5)There were no statistical significance in the patients satisfaction between thetwo groups(RR=0.93,95^001==[0.83,1,04,P=0.18>0.05).3.Compared to hysterectomy:(1)Among patients underwent hysterectomy, the sexual satisfaction increased (P=0.005) and the sexual problems decreased (P=0.002) at6-month follow up. At12months atfer the treatment, the decrease in the sexual problems still exist (P=0.05). At5-year follow up, the partner satisfaction increased (P=0.04).Among theLNG-IUS users，there was no change either in the sexual satisfaction or in the sexualproblems. The satisfaction with partner decreased at12-month follow up (P=0.05)and still keep so at5-year follow up (P=0.001).(2)Compared the QOL scores of the two groups pre-treatment andpost-treatment, three of the five mean domain scores (physical, environmental,environmental-TR) increased in patients underwent hysterectomy, wheres all fivemean domain scores were increased in LNG-IUS users.Conclusion1.LNG-IUS had a supeiror effect than oral medicine in treating menorrhagia.Compared to the oral medicine group, the LNG-IUS group had higher effective rateand lower failure rate.2.LNG-IUS had a similar therapeutic effect with Endometrial ablation for the treatment of menorrhagia. There were no statistical significance in effective rate,amenorrhoea rate and the patient satisfaction between the two group. However, theLNG-IUS group has a higher failure rate than the Endometrial ablation group.3. LNG-IUS was a cost-effective alternative to hysterectomy for the treatment ofmenorrhagia. Hysterectomy lead to improvement to sexual satisfaction and decreasedsexual problems among patients with menorrhagia, while LNG-IUS didn’t have suchan effect. Although both treatments improved health-related QOL, LNG-IUS seemedto have better effects on psychological and social life.