Anchoring levonorgestrel-releasing intrauterine system versus suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis

Background The aim of this study was to compare two levonorgestrel-releasing intrauterine system fixation methods for the treatment of adenomyosis.

The study included patients with adenomyosis who underwent anchoring of the LNG-IUS to the uterine muscle layer using the GyneFix→ intrauterine device (IUD) system and those who underwent LNG-IUS suturing to the uterine muscle layer (experimental and control groups, respectively; n = 21 each), between January 2023 and February 2025. This retrospective study was conducted at the First Affiliated Hospital of Ningbo University. All 42 patients completed LNG-IUS fixation surgery and followed up at 1, 3, and 6 months post-operatively.

The pre-treatment clinical profiles, including age, parity, body weight, body mass index (BMI), incidence of dysmenorrhea and menorrhagia, uterine volume, visual analog scale (VAS) score, hemoglobin (Hb) level, and pictorial blood assessment chart (PBAC) score, were not significantly different between the two groups. The mean operative duration was 13.19 ± 2.23 min in the experimental group and 29.48 ± 3.72 min in the control group (p < 0.01). After placement of the LNG-IUS in both groups, the VAS and PBAC scores were significantly reduced, and the Hb levels were significantly increased compared with the baseline (both p < 0.01). At the 6-month follow-up, the uterine volume was also significantly reduced relative to baseline in both groups (p < 0.01). However, there were no significant between-group differences in post-treatment outcomes, including uterine volume, VAS score, Hb level, PBAC score, and LNG-IUS expulsion rate. One patient in the experimental group experienced LNG-IUS expulsion during the first postoperative menstrual period. In the control group, gynecological examination at 3 months postoperatively showed that the LNG-IUS was displaced into the cervical canal and vagina in one patient.

Both LNG-IUS fixation modalities were effective treatments for adenomyosis, and the expulsion and displacement rates were reduced compared to those placed conventionally. LNG-IUS fixation using the GyneFix→ IUD system was performed more rapidly and had a lower risk of water overload. Similar content being viewed by others Data availability The datasets generated and analyzed during the current study are not publicly available due to their sensitive and potentially personally identifiable nature. Still, they are available from the corresponding author (Dr. Yan) upon reasonable request. Abbreviations - Hb: - Hemoglobin - IUD: - Intrauterine Device - LNG-IUS: - Levonorgestrel-releasing Intrauterine System - PBAC: - Pictorial Blood Assessment Chart - VAS: - Visual Analog Scale - GnRH-a: - Gonadotropin-releasing Hormone Analogs

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None. Research registration number - 1. Name of the registry: National Health insurance information platform. - 2. Unique identifying number or registration ID: MR-33-25-055705. Funding None. Author information Authors and Affiliations Contributions YH conceptualized the idea for this review, formulated the study question and objectives, assisted with the development of the final methods, contributed to the data analysis/ interpretation, and wrote the manuscript. GJH and YH contributed to the writing of the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Ningbo University (2025 Research No. 150RS-01). The data was anonymous, and the requirement for informed consent was therefore waived. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open 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/. About this article Cite this article Yan, H., Gao, Jh. Anchoring levonorgestrel-releasing intrauterine system versus suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03733-2 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12893-026-03733-2