{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:16:06Z","timestamp":1792671366906,"version":"4.5.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite endometrial ablation\/resection being a very successful treatment for women with heavy menstrual bleeding, re\u2010intervention with additional surgery is needed in 12%\u201325% of cases. Introducing a levonorgestrel\u2010intrauterine system (LNG\u2010IUS) immediately after ablation could preserve the integrity of the uterine cavity and suppress the regenerated or non\u2010ablated endometrial tissue. Therefore, this combined treatment can perhaps lower the re\u2010intervention rate. The aim of this systematic review was to assess the impact of the combined treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>The MEDLINE, EMBASE, and Cochrane library were systematically searched. No language restrictions were applied. All types of studies were included reporting on the results of endometrial ablation or resection combined with immediate insertion of LNG\u2010IUS for treatment of heavy menstrual bleeding. The primary outcome was the number of hysterectomies after the ablation procedure. Secondary outcomes included re\u2010intervention rates, removals of LNG\u2010IUS, bleeding pattern, patient satisfaction, adverse effects, and complications. Our protocol was registered in PROSPERO, an international prospective register of systematic reviews under registration number CRD42020151384.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies with a retrospective design and one case series with a follow\u2010up duration varying from 6 to 55\u00a0months were included. In total, 427 women were treated with the combined treatment. The studies described a lower hysterectomy and re\u2010intervention rate after combined treatment compared with treatment with endometrial ablation\/resection alone. Hysterectomy rate varied from 0% to 11% after combined treatment compared with 9.4% to 24% after endometrial ablation\/resection alone. Bleeding patterns and patient satisfaction appeared to be in favor of the combined treatment group. No intra\u2010 or post\u2010operative complications or complications in the removal of LNG\u2010IUS were described. The most reported adverse effects after combined treatment were weight gain, mood changes, and headaches. An additional 11 studies with only an abstract available substantiated these findings. All the included studies had poor methodological quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Based on the available literature, inserting an LNG\u2010IUS immediately after endometrial ablation\/resection seems to lower the hysterectomy and re\u2010intervention rates compared with ablation\/resection alone. However, as only limited observational studies of low methodological quality are available, high\u2010quality research is necessary to confirm the findings of this systematic review.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14219","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T13:04:54Z","timestamp":1624539894000},"page":"1779-1787","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The combined use of endometrial ablation or resection and levonorgestrel\u2010releasing intrauterine system in women with heavy menstrual bleeding: A systematic review"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-0338","authenticated-orcid":false,"given":"Tamara J.","family":"Oderkerk","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Center Veldhoven the Netherlands"},{"name":"Department of Obstetrics and Gynecology Grow\u2010School of Oncology and Developmental Biology Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majorie M.A.","family":"van de Kar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Center Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlijn H.M.","family":"van der Zanden","sequence":"additional","affiliation":[{"name":"Department of Public Health Service GGD Brabant\u2010Zuidoost Helmond the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy M.A.J.","family":"Geomini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Center Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malou C.","family":"Herman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Center Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlies Y.","family":"Bongers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology M\u00e1xima Medical Center Veldhoven the Netherlands"},{"name":"Department of Obstetrics and Gynecology Grow\u2010School of Oncology and Developmental Biology Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318262e320"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldz008"},{"issue":"4","key":"e_1_2_10_4_1","first-page":"Cd002126","article-title":"Progesterone or progestogen\u2010releasing intrauterine systems for heavy menstrual bleeding","author":"Lethaby A","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"e_1_2_10_5_1","first-page":"Cd001501","article-title":"Endometrial resection\/ablation techniques for heavy menstrual bleeding","author":"Lethaby A","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.03.006"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2014.10.020"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003556"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2019.05.022"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_10_11_1","unstructured":"OderkerkT Van de KarM GeominiP BongersM. 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