Long-Term Effects of Levonorgestrel IUD on Endometrial Pathology in Women with Heavy Menstrual Bleeding

Objectives: To assess the long-term effects of LNG-IUD on endometrial pathology in women’s presenting with heavy menstrual blood loss (HMB). Methodology: This prospective experimental study was conducted from February 2023 to January 2024, in the Gynecology Department of Hayatabad Medical Complex, Peshawar. A total of 180 women diagnosed with menorrhagia were enrolled in the study. All insertions were performed under aseptic conditions by experienced gynecologists with at least five years of clinical expertise. Baseline demographic and clinical data were recorded, and all patients underwent Pipelle endometrial sampling before LNG-IUD insertion to assess histology. Patients were evaluated pre-insertion and again at the end of the study (12 months post-insertion). Results: Of the 162 women completing the study, the mean Pictorial Blood Loss Assessment Chart (PBAC) score significantly decreased from 312.6 ± 51.7 to 84.3 ± 29.8 (p < 0.001), and hemoglobin levels increased from 9.4 ± 1.2 g/dL to 12.3 ± 1.1 g/dL (p < 0.001). Histopathological changes included glandular atrophy (79%), stromal decidualization (95%), and vascular remodeling (87%), with no significant increase in hyperplasia or atypia (p = 0.68). Adverse events were minimal, with cramping (12%) and irregular spotting (9%) being the most common. Conclusion: LNG-IUD is a highly effective and safe treatment for menorrhagia, significantly reducing menstrual blood loss, improving anemia, and inducing favorable endometrial changes without increasing the risk of atypia.