{"paper_id":"60da464f-1789-427c-affe-19106dbbff18","body_text":"Abstract\nBackground\nAbnormal uterine bleeding (AUB) is a common reason for gynaecological consultation and hysterectomy. Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective conservative treatment, hysterectomy continues to be offered early in routine practice in India. While LNG-IUS has shown benefit in bleeding control and quality of life, most studies have evaluated it independently. Comparative real-world evidence using standardised quality-of-life tools in women with structural AUB remains limited. This study compared clinical outcomes and patient-reported quality of life following LNG-IUS versus laparoscopic hysterectomy.\nMaterials and Methods\nA prospective observational comparative study was conducted between March 2024 and May 2025 at a tertiary care hospital. Eighty premenopausal women with AUB were allocated to LNG-IUS or laparoscopic hysterectomy based on shared decision-making and clinical suitability. Outcomes were assessed at baseline and six months using the Pictorial Blood Loss Assessment Chart (PBAC), haemoglobin levels, and SF-36 questionnaire (measuring health-related Quality of life).\nResults\nBoth groups showed significant improvement in clinical outcomes and quality of life (QOL). LNG-IUS reduced menstrual blood loss, approximately 59%, with 17.5% achieving amenorrhoea and 20% returning to normal cycles. Seven of eight SF-36 domains improved after LNG-IUS, while hysterectomy improved six domains, with no significant change in pain or physical functioning. LNG-IUS demonstrated high continuation (82.5%) and satisfaction (77.5%) rates, and side effects such as spotting and functional ovarian cysts did not affect acceptability due to anticipatory counselling.\nConclusion\nLNG-IUS serves as an effective alternative to hysterectomy for AUB, improving symptoms and quality of life while avoiding surgical risks. Shared decision-making and standardised follow-up may reduce unnecessary hysterectomies, as several women initially planned for surgery continued LNG-IUS after symptomatic improvement.\nSimilar content being viewed by others\nAbbreviations\n- AUB:\n-\nAbnormal uterine bleeding\n- LNG-IUS:\n-\nLevonorgestrel-releasing intrauterine system\n- QoL:\n-\nQuality of life\n- SF-36:\n-\nShort form-36 health survey\n- PBAC:\n-\nPictorial blood assessment chart\nReferences\nCritchley HOD, Maybin JA, Broder MS, et al. Abnormal uterine bleeding—towards a clinically meaningful classification. 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Effectiveness of levonorgestrel intrauterine system in adenomyosis and heavy menstrual bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024;290:12–22.\nGupta P, Shah S, Rane A. LNG-IUS continuation and clinical response in non-structural AUB: 3C comparative cohort analysis. J Obstet Gynaecol India. 2025;75(1):58–65.\nNational Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. Guideline NG88. 2018. Available from: https://www.nice.org.uk/guidance/ng88. Accessed 29 Nov 2025\nAcknowledgment\nThe authors thank the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, and the clinical nursing staff for their support during patient recruitment and follow-up. The authors also acknowledge the study participants for their cooperation and contribution to this research.\nFunding\nThis research received no external funding.\nAuthor information\nAuthors and Affiliations\nContributions\nDr. Bommareddy Keerthana and Dr. Brihathi Pranavi Dasari contributed equally to this work and are designated as co–first authors. Dr. Bommareddy Keerthana: Conceptualization, data collection, statistical analysis, literature review, manuscript drafting. Dr. Jyothi Shetty: Study design, supervision, critical revision of the manuscript and final approval. Dr. Brihathi Pranavi Dasari: Contributed to study design refinement, statistical analysis, data verification, interpretation of findings, preparation of tables/figures, and co-drafting and critically revising the manuscript. All the authors have read and approved the final manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThere is no conflict of interest among authors.\nClinical Trial Registration\nCTRI/2024/02/062537; REF/2024/01/078065 on 12/02/2024\nConsent for Publication\nThis manuscript has not been published and is not under consideration for publication in any other journal.\nEthics Approval\nAll authors approved the manuscript and its submission to the journal. Ethical committee has approved this study. Obtained from Institutional Ethics Committee, IEC2-557/2023\nInformed Consent\nInformed consent was obtained from all individual participants included in the study. The participants have consented to the submission and publication of relevant data. Identifiable information has been omitted or anonymized to preserve confidentiality.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nDr. Bommareddy Keerthana, MBBS, MS (OBG) is a Junior Resident; Dr. Brihathi Pranavi Dasari, MBBS, MS (OBG) is an Senior Resident; Dr. Jyothi Shetty, MBBS, MD (OBG) is an Professor.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nKeerthana, B., Dasari, B.P. & Shetty, J. Improving the Quality of Life in AUB: A South Indian Experience Comparing Hysterectomy with Levonorgestrel-Releasing Intrauterine System. J Obstet Gynecol India (2026). https://doi.org/10.1007/s13224-026-02371-1\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s13224-026-02371-1","source_license":"CC0","license_restricted":false}