Incidence of Acne in Women Using the Levonorgestrel-Releasing Intrauterine Device: A Systematic Review and Meta-Analysis.

Abstract

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation. To evaluate the incidence of acne among LNG-IUS users. A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024. Randomised clinical trials (RCTs) analysing patients of any age using LNG-IUS at 52 mg, 19.5 mg, or 13.5 mg, with acne reported as an outcome, were included. Statistical analyses were conducted using OpenMeta. Chi-square and Z-tests assessed differences between groups, and study quality was appraised using the ROB-2 tool. Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG-IUS users. The overall acne incidence was 15.0% (95% CI 9.8%-20.3%). Among 2295 users of LNG-IUS 52 mg, incidence reached 19.5% (95% CI 5.2%-33.7%), whereas in 2322 users of LNG-IUS 13.5 mg it was 13.1% (95% CI 8.3%-17.9%) (p < 0.001). Two trials evaluated the 19.5 mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24 years) reported an incidence of 19.3% (95% CI 11.0%-27.5%). Excluding Suhonen et al. yielded pooled proportions of 11.9% (95% CI 1.1%-22.7%) for LNG-IUS 52 mg users, 10.8% (95% CI 6.1%-15.5%) when all dosages were combined, and 9.9% (95% CI 9.0%-10.9%) among young women. Heterogeneity remained substantial in the overall and dosage-specific analyses (I²≈95%-97%); it was eliminated in the young women subgroup (I² = 0%). LNG-IUS 52 mg users showed a higher incidence of acne compared with those using LNG-IUS 13.5 mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users. PROSPERO registration number: CRD42024588771.