Effects of laparoscopic radiofrequency ablation combined with a levonorgestrel-releasing intrauterine system in patients with adenomyosis

To compare the 12-month clinical outcomes of laparoscopic RFA alone with those of laparoscopic RFA combined with LNG-IUS in patients with symptomatic adenomyosis. This single-center retrospective cohort study included 70 patients with adenomyosis who had complete 12-month follow-up data. Based on the treatment documented in their medical records, patients were classified into an RFA-alone group (group A, n = 35) and an RFA-plus-LNG-IUS group (group B, n = 35). The primary outcome was the change in VAS score from baseline to 12 months. Continuous outcomes were analyzed using two-way mixed-design repeated-measures analysis of variance, with particular attention to the group-by-time interaction. Significant group-by-time interactions were observed for VAS score, menstrual volume, and uterine volume at 12 months. Compared with RFA alone, RFA plus LNG-IUS was associated with greater reductions in VAS score (difference in change, − 0.60 points; 95% CI, − 1.06 to − 0.14; P = .012), menstrual volume (− 25.00 mL; 95% CI, − 35.11 to − 14.89; Holm-adjusted P < .001), and uterine volume (− 14.00 cm³; 95% CI, − 17.10 to − 10.90; Holm-adjusted P < .001). At 1 month, the combined-treatment group showed a greater increase in hemoglobin (difference in change, 14.00 g/L; 95% CI, 11.51 to 16.49; Holm-adjusted P < .001) and a greater reduction in CA125 (− 7.10 U/mL; 95% CI, − 11.09 to − 3.11; Holm-adjusted P = .003). No significant group-by-time interactions were observed for white blood cell count, red blood cell count, or platelet count. In this retrospective cohort, adding LNG-IUS to laparoscopic RFA was associated with greater 12-month improvements in pain, menstrual volume, and uterine volume than laparoscopic RFA alone. These preliminary findings require confirmation in larger prospective studies with longer follow-up.