Comparative effectiveness of two hysteroscopic fixation techniques (suture vs. GyneFix anchor) for levonorgestrel-releasing intrauterine system: a retrospective study

Backgrounds The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment for adenomyosis; however, its therapeutic benefits are frequently limited by a high expulsion risk. This study aimed to compare the safety and efficacy of two hysteroscopic fixation techniques in patients at high risk for LNG-IUS expulsion.

This retrospective cohort study included 42 adenomyosis patients with an increased expulsion risk, underwent hysteroscopic LNG-IUS fixation between 2023 and 2025. The primary outcome was the rate of expulsion at 3 months postoperatively. Data were analyzed using the Shapiro-Wilk test, with between-group comparisons performed via the t-test, χ² test, or Fisher’s exact test as appropriate.

According to the surgical technique used, patients were allocated to either the suture fixation group (n = 20) or the anchor fixation group (n = 22). No statistically significant differences in baseline characteristics were detected between the two groups. At three months postoperative, the expulsion rate was 10.0% (2/20) in the suture group and 9.1% (2/22) in the anchor group, showing no statistically detectable difference within the limits of the sample. Both groups demonstrated significant improvements in dysmenorrhea (suture group: P = 0.0001; anchor group: P = 0.006). Operative time was significantly shorter in the anchor fixation group(P = 0.04).

In this exploratory cohort of patients with adenomyosis at high risk of LNG-IUS expulsion, both hysteroscopic fixation techniques were associated with low early expulsion rates and clinically meaningful relief of dysmenorrhea. However, due to the small sample size and exploratory nature of this study, these findings should be considered preliminary. Although no statistically significant difference in expulsion rates was observed between the two methods, the anchor technique demonstrated a procedural advantage in terms of shorter operative time. Similar content being viewed by others Data availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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None. Author information Authors and Affiliations Contributions Jia Wang were responsible for designed the study; ZhenHui Yang and Jian Gu were responsible surgeon; YingXiang Wang were responsible for collected the data; ZhenHui Yang completed the data analysis and results interpretation; Jia Wang and Jian Gu completed the first draft of the article. XiaoMao Li were responsible for the final approval of the manuscript. All authors reviewed, revised, 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. Ethical approval was obtained from the ethics committee of the Third Affiliated Hospital, Sun Yat-sen University (No. II2025-119-01). Written informed consent was obtained from all participants prior to their inclusion in the study. 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. Supplementary Information 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 Wang, J., Yang, Z., Wang, Y. et al. Comparative effectiveness of two hysteroscopic fixation techniques (suture vs. GyneFix anchor) for levonorgestrel-releasing intrauterine system: a retrospective study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04445-8 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04445-8