Improving the Quality of Life of AUB: A South Indian Experience Comparing Hysterectomy With LNG-IUS

Improving the Quality of Life of AUB: A South Indian Experience Comparing Hysterectomy With LNG-IUS | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving the Quality of Life of AUB: A South Indian Experience Comparing Hysterectomy With LNG-IUS Bommareddy Keerthana, Jyothi Shetty, Brihathi Pranavi Dasari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7233996/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Abnormal uterine bleeding (AUB) is a common cause of morbidity in premenopausal women, typically managed by hysterectomy or the levonorgestrel-releasing intrauterine system (LNG-IUS). While hysterectomy offers definitive symptom control, LNG-IUS is increasingly promoted as a uterus-preserving alternative, in line with India’s national health policies under schemes Janani Shishu Suraksha Karyakram (JSSK) and Ayushman Bharat. This study evaluated the effectiveness and impact on quality of life (QoL) of the LNG-IUS compared to total laparoscopic hysterectomy (TLH), while also exploring clinical factors influencing LNG-IUS outcomes, including the potential impact of a cesarean scar niche. Methods: This prospective, comparative cohort study was conducted between March 2024 and May 2025 at a tertiary academic centre. Following their classification using the FIGO PALM-COEIN method, 80 women with AUB were enrolled and assigned to either the TLH group (n = 40) or the LNG-IUS group (n = 40). A rigorous clinical protocol ensured careful patient selection, exclusion of uterine anomalies or distorted cavities, and personalized counselling. Using standardized instruments like Pictorial Blood Loss Assessment Chart (PBAC), SF-36 for QoL, FSFI-6 for sexual function, and Visual Analog Scale (VAS) for dysmenorrhea, results were assessed at baseline and six months later. Results: The LNG-IUS group showed a significant reduction in menstrual blood loss, with mean PBAC scores declining from 243.75 ± 53.8 to 99 ± 10.75 (p < 0.001), accompanied by an improvement in hemoglobin levels. Among 17 women with large, symptomatic adenomyosis (excluding fibroids/polyps), the LNG-IUS achieved a 94% success rate with only one spontaneous expulsion, higher than in similar studies, with a continuation rate of 82.5% likely due to structured counselling and pre-insertion protocols. LNG-IUS users showed significant improvement in 7 out of 8 domains and in FSFI scores (8.44 to 9.08; p = 0.002), with notable gains in pain and sexual well-being. No cases of Mirena migration were recorded, likely due to gynecologist-performed real-time ultrasound and a structured follow-up with immediate post-insertion scan and imaging again after 1 month. Conclusion: The LNG-IUS is a safe, effective, and policy-compliant alternative to hysterectomy for AUB, providing significant improvements in bleeding control, QoL, and sexual function with the added benefit of uterine preservation. Trial Registration CTRI/2024/02/062537, Date of Registration 12/02/2024 Abnormal uterine bleeding LNG-IUS Quality of life SF-36 FSFI PBAC Full Text Additional Declarations No competing interests reported. Supplementary Files PBAC.docx SF36.pdf FSFI6.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7233996","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":519597356,"identity":"74778bff-b090-46a4-9a0f-5491d6316c9b","order_by":0,"name":"Bommareddy Keerthana","email":"","orcid":"","institution":"Kasturba Medical College, Manipal Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Bommareddy","middleName":"","lastName":"Keerthana","suffix":""},{"id":519597357,"identity":"2c0328c8-ac0f-4182-a733-862248882135","order_by":1,"name":"Jyothi Shetty","email":"","orcid":"","institution":"Kasturba 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LNG-IUS","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Abnormal uterine bleeding, LNG-IUS, Quality of life, SF-36, FSFI, PBAC","lastPublishedDoi":"10.21203/rs.3.rs-7233996/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7233996/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eAbnormal uterine bleeding (AUB) is a common cause of morbidity in premenopausal women, typically managed by hysterectomy or the levonorgestrel-releasing intrauterine system (LNG-IUS). While hysterectomy offers definitive symptom control, LNG-IUS is increasingly promoted as a uterus-preserving alternative, in line with India\u0026rsquo;s national health policies under schemes Janani Shishu Suraksha Karyakram (JSSK) and Ayushman Bharat. This study evaluated the effectiveness and impact on quality of life (QoL) of the LNG-IUS compared to total laparoscopic hysterectomy (TLH), while also exploring clinical factors influencing LNG-IUS outcomes, including the potential impact of a cesarean scar niche.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eThis prospective, comparative cohort study was conducted between March 2024 and May 2025 at a tertiary academic centre. Following their classification using the FIGO PALM-COEIN method, 80 women with AUB were enrolled and assigned to either the TLH group (n\u0026thinsp;=\u0026thinsp;40) or the LNG-IUS group (n\u0026thinsp;=\u0026thinsp;40). A rigorous clinical protocol ensured careful patient selection, exclusion of uterine anomalies or distorted cavities, and personalized counselling. Using standardized instruments like Pictorial Blood Loss Assessment Chart (PBAC), SF-36 for QoL, FSFI-6 for sexual function, and Visual Analog Scale (VAS) for dysmenorrhea, results were assessed at baseline and six months later.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe LNG-IUS group showed a significant reduction in menstrual blood loss, with mean PBAC scores declining from 243.75\u0026thinsp;\u0026plusmn;\u0026thinsp;53.8 to 99\u0026thinsp;\u0026plusmn;\u0026thinsp;10.75 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), accompanied by an improvement in hemoglobin levels. Among 17 women with large, symptomatic adenomyosis (excluding fibroids/polyps), the LNG-IUS achieved a 94% success rate with only one spontaneous expulsion, higher than in similar studies, with a continuation rate of 82.5% likely due to structured counselling and pre-insertion protocols. LNG-IUS users showed significant improvement in 7 out of 8 domains and in FSFI scores (8.44 to 9.08; p\u0026thinsp;=\u0026thinsp;0.002), with notable gains in pain and sexual well-being. No cases of Mirena migration were recorded, likely due to gynecologist-performed real-time ultrasound and a structured follow-up with immediate post-insertion scan and imaging again after 1 month.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eThe LNG-IUS is a safe, effective, and policy-compliant alternative to hysterectomy for AUB, providing significant improvements in bleeding control, QoL, and sexual function with the added benefit of uterine preservation.\u003c/p\u003e\u003ch2\u003eTrial Registration\u003c/h2\u003e\u003cp\u003eCTRI/2024/02/062537, Date of Registration 12/02/2024\u003c/p\u003e","manuscriptTitle":"Improving the Quality of Life of AUB: A South Indian Experience Comparing Hysterectomy With LNG-IUS","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 22:29:37","doi":"10.21203/rs.3.rs-7233996/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"903fae82-b499-4548-8510-baa403814652","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T08:24:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 22:29:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7233996","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7233996","identity":"rs-7233996","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}