This analysis portrayed that the levonorgestrel-releasing intrauterine system (LNG-IUS) provides higher satisfaction rate of patients without systemic adverse drug reaction than other treatments and significantly prevents the recurrence of dysmenorrhea. Hence, LNG-IUS might be a treatment option as maintenance therapy after the surgical management for endometriosis.

To compare the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) with other treatments as postoperative maintenance therapy for endometriosis concerning pain reduction, recurrence prevention, side effects and patients’ satisfaction.

The investigators searched MEDLINE, EMBASE, and the Cochrane Library from January 1986 to February 2018. Two evaluators independently extracted and reviewed the prospective and retrospective articles as per the predetermined selection criteria. Outcomes were determined as mean difference (MD), risk ratios (RR) or odds ratios (OR) in a meta-analysis model, using the Revman software.

From a total of 962 studies, 7 studies were selected. These 7 studies comprised of four randomized controlled trials with 212 patients, one prospective cohort study with 88 patients, and two retrospective studies with 191 patients. According to the meta-analysis, LNG-IUS  significantly reduced the pain after surgery (MD = 12.97, 95% CI: 5.55–20.39), with a comparable effect to gonadotropin-releasing hormone analogues (MD = −0.16, 95% CI: −2.02 to 1.70). LNG-IUS was also effective in reducing the recurrence rate (RR = 0.40, 95% CI: 0.26–0.64), with an effect comparable to OC (OR = 1.00, 95% CI: 0.25–4.02) and danazol (RR = 0.30, 95% CI: 0.03–2.81). Also, patients' satisfaction with LNG-IUS was significantly higher than that with OC (OR = 8.60, 95% CI: 1.03–71.86). Vaginal bleeding was significantly higher in the LNG-IUS group as compared to the gonadotropin-releasing hormone analogue group (RR = 27.0, 95% CI: 1.71–425.36).

This meta-analysis portrayed a positive effect of LNG-IUS as postoperative maintenance therapy for endometriosis on pain relief, prevention of dysmenorrhea recurrence, and the patient's satisfaction.