Long-term Efficacy and Safety of Levonorgestrel - releasing Intrauterine System in the Treatment of Adenomyosis: Evidence Mapping and Meta-analysis
Bibliographic record
Abstract
Background: Adenomyosis (AM) is a common benign gynaecologic disease characterized by dysmenorrhea and heavy menstrual bleeding and requires for long-term management. Levonorgestrel - releasing Intrauterine System (LNG-IUS) is a long-acting hormone-releasing uterine device which has benefits in relieving pain and reducing bleeding. Objectives: To summarise the current available evidence regarding the LNG-IUS for the treatment of AM and to identify potential research gaps. Search Strategy: We performed a systematic search in electronic databases including MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI and Wanfang. Selection Criteria: We included studies of adult patients with a diagnosis of AM and focused on treatments with the LNG-IUS combined with conservative therapy. Data Collection and Analysis: A random-effects model was used for meta-analysis. Quality and risk of bias were assessed using the Newcastle Ottawa Scale for non-RCTs and Cochrane risk of bias tool for RCTs. Main Results: Thirty-nine studies compared the LNG-IUS with other conservative therapeutic drugs, and 32 studies investigated LNG-IUS as the post-operative therapeutic management. In patients who received conservative therapies, the most reported comparison was GnRHa+LNG-IUS versus LNG-IUS alone, followed by LNG-IUS versus mifepristone, gestrinone, blank control, GnRH-a, and androgen. Conclusions: Compared with COC and GnRHa, LNG-IUS could maintain a long-term effect in reducing dysmenorrhea and bleeding. Combined therapeutic treatment with GnRH-a and LNG-IUS was more efficacious than LNG-IUS alone in patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, in patients undergoing post-operative therapy, the LNG-IUS showed a significant long-term benefit. Keywords: LNG-IUS evidence mapping adenomyosis
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.024 | 0.052 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".