Levonorgestrel intrauterine system as a management of abnormal uterine bleeding with endometrial hyperplasia without atypia

Background: Endometrial hyperplasia (EH) without atypia is a common cause of abnormal uterine bleeding in peri-menopausal women. Standard management includes progestin therapy, and the levonorgestrel intrauterine system (LNG-IUS) has emerged as a fertility-preserving, minimally invasive option. Aims and Objectives: The aims and objectives of the study are to evaluate the effectiveness of LNG-IUS in the management of peri-menopausal women with EH without atypia. Materials and Methods: A prospective single-center study was conducted on 92 women aged 40–50 years with histologically confirmed EH without atypia. LNG-IUS was inserted following baseline transvaginal sonography and biopsy. Patients were followed at 3, 6, and 12 months with repeat ultrasound, biopsy, hemoglobin (Hb) assessment, and menstrual history. Results: The most affected age group was 43–45 years (56.5%). Mean baseline Hb was 8.9±0.49 g/dL, which significantly improved to 11.7±0.57 g/dL at 12 months (P<0.001). Mean endometrial thickness reduced from 10.3±1.52 mm at baseline to 2.9±0.18 mm at 12 months (P<0.001). By the end of follow-up, 62% of patients achieved amenorrhea, while none reported heavy or irregular heavy menses. Significant symptomatic relief and regression of hyperplasia were noted in the majority of cases. Conclusion: LNG-IUS is a highly effective, conservative treatment for EH without atypia. It provides significant improvements in Hb levels, reduces endometrial thickness, and alleviates menorrhagia, making it a safe, reversible, and fertility-preserving alternative to hysterectomy in peri-menopausal women.