Hysteroscopic suture fixation for levonorgestrel-releasing intrauterine system in adenomyosis feasibility and therapeutic outcomes

Levonorgestrel intrauterine-releasing system (LNG-IUS), an intrauterine device, is recommended for patients with adenomyosis; however, it often shows poor outcomes in these patients because of their large uterine size. This prospective study evaluated the feasibility, short-term therapeutic effectiveness and safety of hysteroscopic suture fixation to secure the LNG-IUS in patients with adenomyosis. Forty-seven patients diagnosed with adenomyosis underwent hysteroscopic LNG-IUS suture fixation between October 2022 and January 2024, with postoperative follow-up for assessing IUD expulsion, treatment outcomes, and adverse events. Postoperative follow-up was conducted for all patients for at least 1 year. In one patient, LNG-IUS expulsion occurred at 3 months post-procedure, while in 2 patients, device displacement was detected through transvaginal sonography. Median visual analog scale scores and pictorial blood loss assessment chart scores for dysmenorrhea and heavy menstrual bleeding (HMB), respectively, were significantly decreased post-insertion. Irregular uterine bleeding emerged as the most frequent adverse event (42.6%). Two patients discontinued the therapy due to persistent dysmenorrhea or HMB. This pilot study demonstrates the technical feasibility and preliminary efficacy of hysteroscopic LNG-IUS suture fixation, with the lower short-term risk of device expulsion supporting further comparative trials. The absence of a control group is the primary limitation, necessitating cautious interpretation of outcomes as preliminary. Standardizing patient selection criteria and a comparative study with larger trials and longer-term follow-up (up to 5 years) is needed to confirm the superiority of this approach.