Cochrane · systematic review · CD002126
Progestogen‐releasing intrauterine systems for heavy menstrual bleeding
Bofill Rodriguez, M, Lethaby, A, Jordan, V · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
19
current version
GRADE rated
16
No studies
2
Included studies
NR
No studies 2 · 10.5%Ungraded 1 · 5.3%Very low 4 · 21.1%Low 7 · 36.8%Moderate 5 · 26.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLNG‐IUS compared to any other medical treatment for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding LNG‐IUS vs any other medical treatment | no estimate extracted | 2 studies · 170 participants | Low Downgraded: risk of bias |
Satisfaction LNG‐IUS vs any other medical treatment | RR 1.28 [1.01, 1.63] | 3 studies · 141 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life LNG‐IUS vs any other medical treatment | no estimate extracted | 1 study · 571 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events LNG‐IUS vs any other medical treatment | RR 0.91 | 1 study · 571 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Withdrawal from treatment for any reason LNG‐IUS vs any other medical treatment | RR 0.49 [0.39, 0.6] | 1 study · 571 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Treatment failure LNG‐IUS vs any other medical treatment | RR 0.34 [0.26, 0.44] | 6 studies · 535 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Cost LNG‐IUS vs any other medical treatment | no estimate extracted | NR | No studies |
LNG‐IUS compared to endometrial ablation for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding LNG‐IUS vs endometrial ablation | no estimate extracted | 2 studies · 122 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Satisfaction with treatment LNG‐IUS vs endometrial ablation | RR 0.95 [0.85, 1.07] | 5 studies · 317 participants | Low Downgraded: risk of bias |
Quality of life LNG‐IUS vs endometrial ablation | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias |
Adverse events LNG‐IUS vs endometrial ablation | RR 2.06 [1.44, 2.94] | 3 studies · 201 participants | Moderate Downgraded: risk of bias |
Treatment failure LNG‐IUS vs endometrial ablation | RR 1.78 [1.09, 2.9] | 5 studies · 320 participants | Low Downgraded: risk of bias |
Cost LNG‐IUS vs endometrial ablation | no estimate extracted | 1 study · 50 participants | Ungraded |
LNG‐IUS compared to hysterectomy for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bleeding LNG‐IUS vs hysterectomy | RR 0.52 [0.39, 0.7] | 1 study · 75 participants | Very low Downgraded: risk of bias |
Satisfaction LNG‐IUS vs hysterectomy | RR 1.01 [0.94, 1.08] | 1 study · 232 participants | Low Downgraded: risk of bias |
Quality of life LNG‐IUS vs hysterectomy | no estimate extracted | 1 study · 221 participants | Low Downgraded: risk of bias |
Adverse events LNG‐IUS vs hysterectomy | no estimate extracted | NR | No studies |
Treatment failure LNG‐IUS vs hysterectomy | RR 48.18 [2.96, 783.22] | 1 study · 236 participants | Low Downgraded: risk of bias |
Cost LNG‐IUS vs hysterectomy | no estimate extracted | 12 participants | Low Downgraded: risk of bias, imprecision |
IUS versus placebo or no treatment for heavy menstrual bleeding
Population: patients with heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean PBAC score at 6 months IUS vs placebo or no treatment | no estimate extracted | 1 study · 40 participants | Low Downgraded: risk of bias |
IUS versus any other medical treatment for heavy menstrual bleeding
Population: patients with heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Percentage reduction in blood loss at end of study (from baseline) ‐ Alkaline haematin method IUS vs any other medical treatment | no estimate extracted | 2 studies · 170 participants | Low Downgraded: risk of bias |
Percentage reduction in blood loss at end of study (from baseline) ‐ PBAC score IUS vs any other medical treatment | no estimate extracted | 3 studies · 335 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of women satisfied with treatment IUS vs any other medical treatment | RR 1.43 [0.78, 2.62] | 1 study · 40 participants | Moderate Downgraded: risk of bias |
Failure of treatment IUS vs any other medical treatment | RR 0.27 [0.18, 0.4] | 3 studies · 327 participants | Very low Downgraded: risk of bias |
IUS versus endometrial ablation for heavy menstrual bleeding
Population: patients with heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
PBAC score at 12 months IUS vs endometrial ablation | no estimate extracted | 2 studies · 122 participants | Very low Downgraded: risk of bias, inconsistency |
Proportion of women satisfied with treatment ‐ After 1 year and up to 5 years IUS vs endometrial ablation | RR 1.12 [0.95, 1.31] | 2 studies · 102 participants | Low Downgraded: risk of bias, inconsistency |
Treatment failure ‐ Up to 12 months IUS vs endometrial ablation | RR 1.58 [0.99, 2.52] | 6 studies · 390 participants | Very low Downgraded: risk of bias |
Proportion of women satisfied with treatment ‐ Within one year IUS vs endometrial ablation | RR 0.95 [0.85, 1.07] | 5 studies · 317 participants | Moderate Downgraded: risk of bias |
Treatment failure ‐ More than 12 months IUS vs endometrial ablation | RR 1.11 [0.72, 1.71] | 4 studies · 259 participants | Very low Downgraded: risk of bias |
IUS versus hysterectomy for heavy menstrual bleeding
Population: patients with heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction with treatment (5 year IUS vs hysterectomy | RR 1.01 [0.94, 1.08] | 1 study · 232 participants | High |