{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T23:56:42Z","timestamp":1790553402249,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The levonorgestrel\u2010releasing intrauterine system (LNG\u2010IUS) is a widely used long\u2010term contraceptive with high continuation rates, but acne may lead to discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the incidence of acne among LNG\u2010IUS users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>Randomised clinical trials (RCTs) analysing patients of any age using LNG\u2010IUS at 52\u2009mg, 19.5\u2009mg, or 13.5\u2009mg, with acne reported as an outcome, were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>Statistical analyses were conducted using OpenMeta. Chi\u2010square and Z\u2010tests assessed differences between groups, and study quality was appraised using the ROB\u20102 tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>\n                      Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG\u2010IUS users. The overall acne incidence was 15.0% (95% CI 9.8%\u201320.3%). Among 2295 users of LNG\u2010IUS 52\u2009mg, incidence reached 19.5% (95% CI 5.2%\u201333.7%), whereas in 2322 users of LNG\u2010IUS 13.5\u2009mg it was 13.1% (95% CI 8.3%\u201317.9%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Two trials evaluated the 19.5\u2009mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24\u2009years) reported an incidence of 19.3% (95% CI 11.0%\u201327.5%). Excluding Suhonen et\u00a0al. yielded pooled proportions of 11.9% (95% CI 1.1%\u201322.7%) for LNG\u2010IUS 52\u2009mg users, 10.8% (95% CI 6.1%\u201315.5%) when all dosages were combined, and 9.9% (95% CI 9.0%\u201310.9%) among young women. Heterogeneity remained substantial in the overall and dosage\u2010specific analyses (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u224895%\u201397%); it was eliminated in the young women subgroup (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LNG\u2010IUS 52\u2009mg users showed a higher incidence of acne compared with those using LNG\u2010IUS 13.5\u2009mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG\u2010IUS users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO registration number: CRD42024588771<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70108","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T08:51:09Z","timestamp":1766393469000},"page":"590-597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of Acne in Women Using the Levonorgestrel\u2010Releasing Intrauterine Device: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8525-0575","authenticated-orcid":false,"given":"Elaine Cristina Fontes","family":"de Oliveira","sequence":"first","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9076-6562","authenticated-orcid":false,"given":"Frederico Timm Rodrigues","family":"de Sousa","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5091-8874","authenticated-orcid":false,"given":"Felipe Augusto Oliveira","family":"Lemos","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1056-8687","authenticated-orcid":false,"given":"Ciro Peixoto","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4717-9541","authenticated-orcid":false,"given":"Ana Luiza Lunardi","family":"Rocha","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2015.5191"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2022.09.001"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/13625187.2024.2379363"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/410809"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003880"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12149"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2010.03919.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.12.051"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2014.03.004"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.01.015"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0010-7824(94)90109-0"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.02.008"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(01)01909-4"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2003.11.008"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1515\/med-2024-0914"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/13625187.2016.1212987"},{"key":"e_1_2_12_19_1","first-page":"E144","article-title":"A Randomized Phase III Study Comparing the 13.5 Mg Total Dose Levonorgestrel Intrauterine Contraceptive System (LNG\u2010IUS 13.5mg) With the Subdermal Etonogestrel (ENG) Contraceptive Implant Over 12 Months of Use","volume":"131","author":"Apter D.","year":"2015","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.12.003"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000019"},{"key":"e_1_2_12_22_1","unstructured":"WHO \u201cYoung Peopl\u00e9s Health \u2013 A Challenge for Society. 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