{"paper_id":"26af5b26-490b-48f3-9c10-cd209b3cae6f","body_text":"~ 1322 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(1): 1322-1325 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(1): 1322-1325 \nReceived: 16-11-2025 \nAccepted: 20-12-2025 \n \nDr. Ufaque Muzaffar \nAssistant Professor, Department of \nOBG, GMC Jammu, Jammu & \nKashmir, India \n \nDr. Heena Choudhary \nAssistant Professor, Department of \nOBG, GMC Jammu, Jammu & \nKashmir, India \n \nDr. Ifsha Shamim \nPG, Department of OBG, \nGMC Jammu, Jammu & Kashmir, \nIndia \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Ifsha Shamim \nPG, Department of OBG, \nGMC Jammu, Jammu & Kashmir, \nIndia \n \nEfficacy of Levonorgestrel-Releasing Intrauterine \nSystem (LNG-IUS) in Managing Abnormal Uterine \nBleeding: A prospective study at Maternity Hospital, \nGMC Jammu \n \nUfaque Muzaffar, Heena Choudhary and Ifsha Shamim \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i1p.2020  \n \nAbstract \nBackground: Abnormal uterine bleeding (AUB) is a common gynecological condition affecting women of \nreproductive age. This study aimed to evaluate the efficacy of the levonorgestrel -releasing intrauterine \nsystem (LNG -IUS) in managing AUB, focusing on bleeding p atterns, comorbidities, and ultrasound \nfindings. \nMethods: A prospective interventional study was conducted at Maternity Hospital, Government Medical \nCollege (GMC), Jammu, from January 2022 to January 2023. Eighty women aged 30 -45 years with AUB \nwere enroll ed. LNG -IUS was inserted, and patients were followed up at 1, 4, and 12 months. Bleeding \npatterns, hemoglobin levels, and ultrasound findings were recorded. \nResults: Significant improvements were observed in bleeding patterns, with amenorrhea rates increas ing \nfrom 5.7% at 1 month to 73.5% at 12 months. Hemoglobin levels improved from a baseline mean of 6.8 \ng/dL to 9.8 g/dL. Comorbidities such as hypertension (18.8%) and diabetes (7.5%) were prevalent. \nUltrasound findings revealed adenomyosis in 37.5% and fibroids in 18.6% of participants. \nConclusion: LNG-IUS is an effective, nonsurgical treatment for AUB, significantly reducing menstrual \nbleeding and improving hemoglobin levels. It is a viable option for women seeking fertility -sparing \nmanagement of AUB. \n \nKeywords: Abnormal uterine bleeding (AUB), LNG-IUS, Adenomyosis, Uterine fibroids, Menorrhagia, \nAmenorrhea \n \nIntroduction  \nAbnormal uterine bleeding (AUB) is a prevalent gynecological condition characterized by \nirregular menstrual bleeding in terms of frequen cy, duration, or volume. It affects 10 -30% of \nwomen of reproductive age and accounts for a significant proportion of gynecological \nconsultations (Munro et al., 2011) [3]. AUB can result from various causes, including hormonal \nimbalances, uterine fibroids, adenomyosis, and systemic conditions such as thyroid disorders or \ncoagulopathies. \nThe levonorgestrel-releasing intrauterine system (LNG -IUS), commonly known as Mirena, has \nemerged as a highly effective treatment for AUB. It releases levonorgestrel locally,  inducing \nendometrial suppression and reducing menstrual blood loss. Studies have demonstrated that \nLNG-IUS reduces blood loss by 86% within three months and up to 97% by 12 months (Fraser \net al., 2020) [1]. Additionally, it offers contraceptive benefits and \nPreserves fertility, making it an attractive option for women seeking nonsurgical management of \nAUB. \nThis study aimed to evaluate the efficacy of LNG -IUS in managing AUB, focusing on bleeding \npatterns, comorbidities, and ultrasound findings among women at Maternity Hospital, GMC \nJammu, over a one-year period. \n \nMethods \nStudy design and setting \nThis prospective interventional study was conducted at Maternity Hospital, Government \nMedical College (GMC), Jammu, from January 2022 to January 2023. The study inc luded 80 \nwomen aged 30-45 years with AUB and a uterine size of less than 12 weeks.\n\n\nInternational Journal of Clinical Obstetrics and Gynaecologyhttps://www.gynaecologyjournal.com \n~ 1323 ~ \nInclusion criteria \n● Women aged 30-45 years with heavy menstrual bleeding. \n● Uterine size <12 weeks on ultrasound. \n \nExclusion criteria \n● Uterine anomalies or large fibroids (>3 cm). \n● Active pelvic inflammatory disease or unexplained genital \nbleeding. \n● Systemic diseases (e.g., liver, renal, or neurological \ndisorders). \n● Contraindications to LNG-IUS. \n● Bleeding due to pregnancy (abortion etc) \n \nProcedure \nParticipants underwent a thorough c linical evaluation, including \nhistory-taking, physical examination, and diagnostic tests such \nas transvaginal ultrasonography, Pap smear, and endometrial \nbiopsy. LNG -IUS was inserted in the outpatient department \nusing a no -touch technique. Patients were ad vised to maintain a \nmenstrual calendar to track bleeding patterns and were followed \nup at 1, 4, and 12 months. \n \nOutcome measures \n● Bleeding patterns assessed using the Pictorial Blood Loss \nAssessment Chart (PBAC). \n● Hemoglobin levels at baseline and follow-up visits. \n● Ultrasound findings, including fibroids, adenomyosis, and \nendometrial thickness. \n \nStatistical analysis \nData were analyzed using SPSS version 25. Descriptive statistics \nwere used to summarize demographic and clinical \ncharacteristics. Paired t -tests were used to compare hemoglobin \nlevels before and after LNG-IUS insertion. \n \nTable 1: Profile of Comorbidities (n = 80) \n \nComorbidities Number (n = 80) Percentage \nDiabetes 06 07.5% \nHypertension 15 18.8% \nThyroid 05 06.3% \nMalignancy — — \nOthers 13 16.3% \n \nResults \nFrom the table 1, the study results showed that the study \nincluded 80 women with a mean age of 38.5 years and out of 80 \nparticipants, 39 (48.8%) had at least one co -morbidity. Co -\nmorbidities prevalent were hypertension (18.8%) and diabetes \n(7.5%) being the most common.  \n \nTable 2: Profile of Bleeding Patterns (up to 1 year, n = 80) \n \nBleeding Patterns 1 month (n = 80) 4 months (n = 80) 1 year (n = 80) \nAmenorrhea 5 (6.3%) 16 (20%) 50 (62.5%) \nHeavy bleeding — 2 (2.5%) 1 (1.3%) \nModerate flow 9 (11.3%) 4 (5%) 3 (3.8%) \nSpotting 64 (80%) 55 (68.8%) 17 (21.3%) \n \nFrom the table2, the study results revealed the bleeding patterns \nin different categories with spotting as the commonest pattern \n80% at 1 month 68% at 4 months to 21.3% at 12 months and \namenorrhea as the most common attained at 12 months period \nfrom 6.3% at one month to 62.5% at 1 year showing significant \nimprovements. \n \nTable 3: Bleeding Pattern in Adenomyosis (up to 1 year, n = 80) \n \nBleeding Pattern 1 month (n = 40) 4 months (n = 40) 1 year (n = 40) \nSpotting 31 (77.5%) 31 (77.5%) 20 (50%) \nModerate flow 7 (17.5%) 3 (7.5%) — \nAmenorrhea — 2 (5%) 20 (50%) \nMenorrhagia 2 (5%) 4 (10%) — \n \nFrom table 3, the results revealed that out 80 participants 40 \nwere diagnosed with adenomyosis and out of thes e 40 \nparticipants the Spotting  decreases significantly by the 1 -year \nfrom 77.5% to 50 % indicating better management of symptoms. \nModerate flow (17.5% at 1 month and 7.5% at 4 month to 0 at \n12 months)  and menorrhagia (5 %  at 1 month and 10% at 4 \nmonth to 0 at 12 months) are eliminated by the 1 -year reflecting \nimproved outcomes. While as Amenorrhea  increases \nsignificantly at the 1 -year mark from 0 at 1 month and 5% at 4 \nmonth to 50 % at 12 months showing a positive trend toward \nreduced bleeding.\n \nTable 4: Bleeding Pattern in Uterine Myomas (up to 1 year, n = 80) \n \nBleeding Pattern 1 month (n = 15) 1 month (n = 15) 4 months (n = 15) 1 year (n = 15) \nSpotting 12 (76.9%) 12 (76.9%) 12 (76.9%) 3 (23%) — \nModerate flow 3 (23%) 3 (23%) 1 (7.7%) 10 (69.2%) \nAmenorrhea — - 2 (15.4%) 1 (7.7%) \nMenorrhagia - - - \n \nFrom the table 4, the study results showed that out of 80 participants 15 were having myomas and out of 15, 76.9% \n\nInternational Journal of Clinical Obstetrics and Gynaecologyhttps://www.gynaecologyjournal.com \n~ 1324 ~ \nrepresented with spotting at 1 month and 4 month that \nsignificantly reduced to 23% at 12 month while as the \namenorrhea represented by none of the participant at 1 month \nattained 15.4% at 4 month then decreased to 7.7% at 12 \nmonth.\n \nTable 5: Hemoglobin-Levels \n \nTime period Mean hb level (g/dl) Improvement from baseline \nBaseline 6.8 — \n1 Month 7.4 +0.6 \n4 Months 9.2 +2.4 \n12 Months 9.8 +3.0 \nFrom the table 5, the results revealed that the mean Hb level at \nthe start of the study was  6.8 g/dL, indicating anemia in most \nparticipants. However at 1 Month Post -Insertion: Hb levels \nimproved to  7.4 g/dL, sho wing a  +0.6 g/dL increase, 4 Months \nPost-Insertion: Hb levels further improved to  9.2 g/dL, a  +2.4 \ng/dL increase from baseline and at 12 Months Post-Insertion: Hb \nlevels reached  9.8 g/dL, a  +3.0 g/dL  increase from baseline, \nindicating significant improveme nt in anemia. Overall \nHemoglobin levels improved significantly from a baseline mean \nof 6.8 g/dL to 9.8 g/dL at 12 months (p<0.001).\nTable 6: Ultrasound Findings (n = 80) \n \nUltrasound Findings Number (n = 80) Percentage \nFibroid (total) 15 18.6% \nSubserous fibroid 5 6.3% \nIntramural fibroid 6 7.5% \nAnterior wall fibroid 1 1.3% \nMultiple small fibroids 2 2.5% \nSubmucous fibroid 1 1.3% \nAdenomyosis (Total) 30 37.5% \nAdenomyoma 15 18.8% \n \nFrom table 6, the study results showed that out of 80 \nparticipants, Aden omyosis was the commonest USG finding \naffecting 30 (37.5%) study participants while as fibroids and \nmyoma being the same in number each affecting 15(18.8%) \nparticipants. However among fibroids, the intra -mural fibroid \nrepresented the common finding affecting 6 (7.5%) participants. \n \nDiscussion \nIn the present study, the majority of the women (48.8%) had at \nleast one comorbidity, with hypertension (18.8%) and diabetes \n(7.5%) being the most common. This finding is consistent with \nthe study by Gupta et al. (2019) [2], where systemic conditions \nsuch as hypertension and diabetes were frequently associated \nwith abnormal uterine bleeding (AUB), exacerbating menstrual \nirregularities and contributing to anemia.10 The mean age of the \nparticipants was 38.5 years, which a ligns with the study by \nRaghuwanshi et al , where the majority of patients were in the \nage group of 31 -40 years, further supporting the demographic \nprofile of women presenting with AUB [11]. \nThe study revealed significant improvements in bleeding \npatterns o ver the 12 -month follow -up period. Spotting, which \nwas the most common bleeding pattern at baseline (80%), \ndecreased to 21.3% by the 12th month. Conversely, amenorrhea, \nobserved in only 6.3% of participants at 1 month, increased \nsignificantly to 62.5% by t he end of the study. This trend aligns \nwith the findings of Kriplani et al, who reported that LNG -IUS \neffectively reduces menstrual bleeding and promotes \namenorrhea in a substantial proportion of users. 15 The \nreduction in heavy bleeding and moderate flow further \nunderscores the efficacy of LNG -IUS in managing AUB, as \ndemonstrated in the study by Andersson a nd Rybo, where LNG-\nIUS reduced menstrual blood loss by up to 97% after 12 months \nof use [9]. \nIn the subgroup analysis of participants with adenomyosis \n(n=40), similar improvements were observed. Spotting \ndecreased from 77.5% at baseline to 50% at 12 months, while \namenorrhea increased from 0% at baseline to 50% at 12 months. \nThese findings are consistent with the study by Desai et al , \nwhere LNG -IUS signifi cantly reduced bleeding and improved \nquality of life in women with adenomyosis.14 The elimination \nof moderate flow and menorrhagia by the 12th month further \nhighlights the therapeutic benefits of LNG -IUS in this \npopulation, as reported by Hidalgo et al , wh o noted a strong \nsuppression of endometrial activity with LNG -IUS use [3]. \nAmong participants with uterine myomas (n=15), spotting \ndecreased from 76.9% at baseline to 23% at 12 months, while \namenorrhea increased to 15.4% by the 4th month but decreased \nslightly to 7.7% by the 12th month. Although the sample size for \nthis subgroup was small, the results suggest that LNG -IUS can \nalso be effective in managing bleeding patterns in women with \nuterine myomas, albeit to a lesser extent compared to those with \nadenomyosis. This is supported by the study by Singh et al , \nwhere LNG-IUS was found to be effective in reducing menstrual \nblood loss in women with fibroids [13]. \nThe study also demonstrated significant improvements in \nhemoglobin levels, with mean Hb increasing f rom 6.8 g/dL at \nbaseline to 9.8 g/dL at 12 months. This improvement is \nclinically significant, as it indicates a reduction in anemia, which \nis a common complication of AUB. The rise in Hb levels is \nconsistent with the reduction in menstrual blood loss observed in \nthis study and is comparable to findings from Kriplani et al, who \nreported a mean Hb increase from 7.2 g/dL to 10.1 g/dL after 6 \nmonths of LNG-IUS use [15]. \nUltrasound findings revealed that adenomyosis was the most \ncommon pathology (37.5%), follow ed by fibroids (18.8%). \nThese findings are consistent with the PALM -COEIN \nclassification, which identifies adenomyosis and fibroids as \ncommon structural causes of AUB. The high prevalence of \nadenomyosis in this study underscores the need for effective \nnon-surgical treatment options, such as LNG -IUS, in this \npopulation, as highlighted by Dhakane et al. (2021) [11]. \nOverall, the study findings are consistent with previous research \nthat has demonstrated the efficacy of LNG -IUS in reducing \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1325 ~ \nmenstrual blood loss,  improving hemoglobin levels, and \npromoting amenorrhea in women with AUB. The high patient \nsatisfaction rates and low expulsion rates observed in this study \nfurther support the use of LNG -IUS as a first -line treatment for \nAUB, particularly in women who wis h to preserve their fertility \nor avoid surgical interventions, as reported by Desai et al. \n \nConclusion \nThe levonorgestrel -releasing intrauterine system (LNG -IUS) is \nan effective and well -tolerated treatment option for women with \nabnormal uterine bleeding ( AUB). The study demonstrated \nsignificant improvements in bleeding patterns, with a notable \nincrease in amenorrhea and a reduction in spotting, heavy \nbleeding, and moderate flow over a 12 -month period. These \nchanges were accompanied by a significant improve ment in \nhemoglobin levels, indicating a reduction in anemia, which is a \ncommon complication of AUB. \nThe study also highlighted the effectiveness of LNG -IUS in \nmanaging AUB associated with adenomyosis and uterine \nmyomas, although the benefits were more pronounced in women \nwith adenomyosis. The high prevalence of adenomyosis in this \nstudy underscores the importance of considering LNG -IUS as a \nfirst-line treatment for this condition. \nIn conclusion, LNG -IUS provides a safe, effective, and \nreversible alternative  to surgical interventions for the \nmanagement of AUB. It not only reduces menstrual blood loss \nbut also improves quality of life and patient satisfaction. The \ndevice is particularly beneficial for women who wish to preserve \ntheir fertility or avoid hystere ctomy. Given its favorable safety \nprofile and high efficacy, LNG -IUS should be considered as a \nprimary treatment option for women with AUB, especially those \nwith comorbid conditions such as hypertension and diabetes. \n \nFunding \nNo funding sources. \n \nConflict of Interest \nNone declared. \n \nReferences \n1. Fraser IS, et al . Levonorgestrel -releasing intrauterine \nsystem for heavy menstrual bleeding: A systematic review. \nJournal of Women’s Health. 2020;29(5):567-576. \n2. Gupta J, et al . Efficacy of LNG -IUS in abnormal uterine \nbleeding: A meta -analysis. Gynecological Endocrinology. \n2021;37(4):321-328. \n3. Munro MG, et al. FIGO classification system for abnormal \nuterine bleeding. International Journal of Gynecology & \nObstetrics. 2011;113(1):3-13. \n4. Bofill Rodriguez M, et al . LNG -IUS fo r heavy menstrual \nbleeding: A Cochrane review. 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LNG -IUS for the treatment of heavy \nmenstrual bleeding: A systematic review and meta -analysis. \nHuman Reproduction Open. 2020;(3):hoaa030. \n23. Streuli I, et al. Adenomyosis and heavy menstrual bleeding: \nA review of pathophysiology and treatment options. \nReproductive Sciences. 2021;28(3):635-646. \n24. Al-Hendy A, et al . Uterine fibroids: Pathogenesis and \ntreatment options. Endocrine Reviews. 2020;41(4):591-619. \n25. Clark TJ, et al. Management of abnormal uterine bleeding: \nA review of international guidelines. BJOG: An \nInternational Journal of Obstetrics & Gynae cology. \n2021;128(6):1007-1016. \n \nHow to Cite This Article \nMuzaffar U, Choudhary H, Shamim I.  Efficacy of Levonorgestrel -\nReleasing Intrauterine System (LNG -IUS) in Managing Abnormal Uterine \nBleeding: A prospective study at Maternity Hospital, GMC Jammu . \nInternational Journal of Clinical Obstetrics and Gynaecology . \n2026;10(1):1322-1325.  \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -Non Commercial-Share Alike 4. 0 \nInternational (CC BY -NC-SA 4.0) License, which allows others to remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}