{"paper_id":"ca007d72-5fc0-4d66-844f-d8013069f56f","body_text":"Abstract\nObjective\nTo evaluate the clinical efficacy and safety of hysteroscopic Mirena ring broken-arm slipknot suture fixation (BA) compared with non-broken-arm slipknot suture fixation (NBA) and Giman ring anchor fixation (Giman) for the treatment of adenomyosis (AM).\nMethods\nA total of 102 patients with AM treated from October 2023 to July 2025 were retrospectively enrolled and divided into three groups: BA group (n = 40), NBA group (n = 45), and Giman group (n = 17). Clinical efficacy, pain scores (VAS), menstrual blood loss (PBAC), sex hormone levels (E2, FSH, LH), endometrial thickness, and uterine cavity depth were compared using generalized estimating equations (GEE), repeated measures ANOVA, and difference-in-differences (DID) models. Causal forest analysis was applied to estimate individualized treatment effects. Adverse events were assessed by Log-binomial regression.\nResults\nThe overall effective rate was 92.50% in the BA group, 84.44% in the NBA group, and 64.71% in the Giman group (P < 0.05). GEE analysis showed that both the BA and NBA groups had significantly lower PBAC and VAS scores compared with the Giman group across all follow-up time points (P < 0.05). Repeated measures ANOVA revealed significant interaction effects between treatment method and time on sex hormone levels (P < 0.001). DID analysis demonstrated that the BA group had the greatest reduction in endometrial thickness and uterine cavity depth. The total adverse event rate was significantly lower in the BA group than in the other two groups (RR < 1, P < 0.05).\nConclusion\nIn this retrospective cohort, hysteroscopic Mirena ring broken-arm slipknot suture fixation was associated with better 12-month clinical outcomes and fewer adverse events compared with the NBA and Giman approaches for treating AM.\nAcknowledgements\nNot applicable.\nFunding\nNo external funding was received for this study.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthics approval and consent to participate\nThis retrospective study was conducted in accordance with the Declaration of Helsinki. The study protocol was reviewed and approved by the Institutional Ethics Committee of Shenzhen Bao’an District Songgang People’s Hospital (No.IRB-PJ-2023-065). Written informed consent was obtained from all participants prior to enrollment.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.\nAbout this article\nCite this article\nFeng, G., Chen, G., Nie, Z. et al. Clinical efficacy of hysteroscopic Mirena ring broken-arm slipknot suture fixation for adenomyosis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04650-5\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04650-5","source_license":"CC0","license_restricted":false}