OBJECTIVE:To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 microg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age. DESIGN:A systematic review and meta-analysis of randomised controlled trials. IDENTIFICATION:Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field. MAIN OUTCOME MEASURES:Unplanned pregnancy and continuation of contraceptive method. RESULTS:Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380A intrauterine devices) and those < or = 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices < or = 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. CONCLUSIONS:The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.

译文

目的:评估育龄妇女左炔诺孕酮释放(每天20微克)子宫内系统(LNG-20)与可逆避孕方法的相对避孕效果,耐受性和可接受性。
设计:对随机对照试验的系统评价和荟萃分析。
鉴定:通过七个数据库,并与从事避孕领域工作的研究人员和组织联系,对研究进行了鉴定。
主要观察指标:计划外怀孕和继续避孕方法。
结果:符合纳入标准的七项随机对照试验中,有五项纳入荟萃分析。四是将LNG-20子宫内系统与非激素子宫内装置进行比较。将LNG-20子宫内系统与子宫内设备进行了比较,分为两类,即> 250 mm3的设备(铜T 380 Ag和铜T 380A子宫设备)和≤250 mm3的设备(Nova-T,T 220C铜和200子宫内设备)设备)。与宫内节育器使用者小于或等于250 mm3相比,LNG-20宫腔内系统使用者的怀孕率显着降低,而异位妊娠的可能性也大大降低。与使用宫内节育器> 250 mm3的女性相比,LNG-20宫内节育器系统使用者更容易发生闭经和排出装置。由于激素的副作用和闭经,LNG-20宫内节育器使用者比所有宫内节育器使用者停药的可能性要高得多。当将LNG-20子宫内系统与Norplant-2进行比较时,LNG-20使用者经历寡聚性羊水的可能性明显更高,但经历长时间的出血和斑点的可能性明显降低。
结论:LNG-20子宫内系统的有效性与其他避孕方法相近或优于其他避孕方法。闭经是终止LNG-20子宫内系统的主要原因,通常是不必要的,因为这种终末器官出血抑制作用是良性的,与正常的雌激素水平有关。选择避孕方法的妇女在接受避孕前咨询时应被告知可能的闭经,并且将无出血视为积极的结果。

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