Anchoring levonorgestrel-releasing intrauterine system versus suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis

The aim of this study was to compare two levonorgestrel-releasing intrauterine system fixation methods for the treatment of adenomyosis. The study included patients with adenomyosis who underwent anchoring of the LNG-IUS to the uterine muscle layer using the GyneFix→ intrauterine device (IUD) system and those who underwent LNG-IUS suturing to the uterine muscle layer (experimental and control groups, respectively; n = 21 each), between January 2023 and February 2025. This retrospective study was conducted at the First Affiliated Hospital of Ningbo University. All 42 patients completed LNG-IUS fixation surgery and followed up at 1, 3, and 6 months post-operatively. The pre-treatment clinical profiles, including age, parity, body weight, body mass index (BMI), incidence of dysmenorrhea and menorrhagia, uterine volume, visual analog scale (VAS) score, hemoglobin (Hb) level, and pictorial blood assessment chart (PBAC) score, were not significantly different between the two groups. The mean operative duration was 13.19 ± 2.23 min in the experimental group and 29.48 ± 3.72 min in the control group (p < 0.01). After placement of the LNG-IUS in both groups, the VAS and PBAC scores were significantly reduced, and the Hb levels were significantly increased compared with the baseline (both p < 0.01). At the 6-month follow-up, the uterine volume was also significantly reduced relative to baseline in both groups (p < 0.01). However, there were no significant between-group differences in post-treatment outcomes, including uterine volume, VAS score, Hb level, PBAC score, and LNG-IUS expulsion rate. One patient in the experimental group experienced LNG-IUS expulsion during the first postoperative menstrual period. In the control group, gynecological examination at 3 months postoperatively showed that the LNG-IUS was displaced into the cervical canal and vagina in one patient. Both LNG-IUS fixation modalities were effective treatments for adenomyosis, and the expulsion and displacement rates were reduced compared to those placed conventionally. LNG-IUS fixation using the GyneFix→ IUD system was performed more rapidly and had a lower risk of water overload.