Objective To evaluate the risk of recurrence or metastasis of breast cancer by LNG-IUS via meta-analysis. Methods We searched literature in the PubMed, Web of Science, Cochrane, EMBASE, CBM, CNKI, VIP, and WanFang database.The retrieval period was from January 2014 to October 2021.Data extraction and quality evaluation were conducted for the included randomized controlled study (RCT) to analyze whether LNG-IUS can increase the risk of recurrence or metastasis of breast cancer. Results A total of 1309 Chinese and English studies were retrieved; 5 RCTs were included in this study, and 446 patients were enrolled.The combined total effect value in the fixed-effect model with RD (95%CI)0.03(-0.03-0.08), Z=1.05, P=0.29) indicated that the LNG-IUS+tamoxifen group did not increase the risk of recurrence or metastasis of breast cancer compared with the tamoxifen group.The funnel diagram was basically symmetrical, suggesting that the publication bias was small. Conclusion Wearing the LNG-IUS does not increase the risk of relapse or metastasis of breast cancer significantly, and it provides certain safety for patients with breast cancer.