Comparative effectiveness of two hysteroscopic fixation techniques (suture vs. GyneFix anchor) for levonorgestrel-releasing intrauterine system: a retrospective study

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment for adenomyosis; however, its therapeutic benefits are frequently limited by a high expulsion risk. This study aimed to compare the safety and efficacy of two hysteroscopic fixation techniques in patients at high risk for LNG-IUS expulsion. This retrospective cohort study included 42 adenomyosis patients with an increased expulsion risk, underwent hysteroscopic LNG-IUS fixation between 2023 and 2025. The primary outcome was the rate of expulsion at 3 months postoperatively. Data were analyzed using the Shapiro-Wilk test, with between-group comparisons performed via the t-test, χ² test, or Fisher’s exact test as appropriate. According to the surgical technique used, patients were allocated to either the suture fixation group (n = 20) or the anchor fixation group (n = 22). No statistically significant differences in baseline characteristics were detected between the two groups. At three months postoperative, the expulsion rate was 10.0% (2/20) in the suture group and 9.1% (2/22) in the anchor group, showing no statistically detectable difference within the limits of the sample. Both groups demonstrated significant improvements in dysmenorrhea (suture group: P = 0.0001; anchor group: P = 0.006). Operative time was significantly shorter in the anchor fixation group(P = 0.04). In this exploratory cohort of patients with adenomyosis at high risk of LNG-IUS expulsion, both hysteroscopic fixation techniques were associated with low early expulsion rates and clinically meaningful relief of dysmenorrhea. However, due to the small sample size and exploratory nature of this study, these findings should be considered preliminary. Although no statistically significant difference in expulsion rates was observed between the two methods, the anchor technique demonstrated a procedural advantage in terms of shorter operative time.