Improving the Quality of Life in AUB: A South Indian Experience Comparing Hysterectomy with Levonorgestrel-Releasing Intrauterine System

Background Abnormal 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.

A 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).

Both 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.

LNG-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. Similar content being viewed by others Abbreviations - AUB: - Abnormal uterine bleeding - LNG-IUS: - Levonorgestrel-releasing intrauterine system - QoL: - Quality of life - SF-36: - Short form-36 health survey - PBAC: - Pictorial blood assessment chart

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The authors also acknowledge the study participants for their cooperation and contribution to this research. Funding This research received no external funding. Author information Authors and Affiliations Contributions Dr. 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. Corresponding author Ethics declarations Conflict of interest There is no conflict of interest among authors. Clinical Trial Registration CTRI/2024/02/062537; REF/2024/01/078065 on 12/02/2024 Consent for Publication This manuscript has not been published and is not under consideration for publication in any other journal. Ethics Approval All authors approved the manuscript and its submission to the journal. Ethical committee has approved this study. Obtained from Institutional Ethics Committee, IEC2-557/2023 Informed Consent Informed 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. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dr. 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. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer 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. About this article Cite this article Keerthana, 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 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s13224-026-02371-1