Hysteroscopic Suture Fixation of a Levonorgestrel-Releasing Intrauterine System for Symptomatic Adenomyosis

Although the levonorgestrel-releasing intrauterine system (LNG-IUS) provides sustained local hormonal treatment, displacement and expulsion may limit continued drug exposure in women with enlarged or anatomically unfavorable uterine cavities. This prospective, non-randomized comparative cohort study consecutively enrolled 180 women with symptomatic adenomyosis between January 2022 and December 2024.

Ninety participants underwent hysteroscopic fundal suture fixation and 90 underwent conventional placement. The primary outcome was partial or complete expulsion within 12 months; secondary assessments included device position, dysmenorrhea, menstrual blood loss, hemoglobin concentration, uterine volume, WHOQOL-BREF scores, adverse events, and reinterventions. Partial or complete expulsion occurred in 4.4% of the fixation group and 15.6% of the conventional-placement group, an absolute risk difference of 11.1 percentage points.