Comparison of the effects of levonorgestrel-releasing intrauterine system and dienogest treatment on systemic inflammatory markers (NLR, PLR, SII) and anemia parameters in patients with adenomyosis at 6 months

OBJECTIVE: To compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) and dienogest (DNG) on systemic inflammatory markers and anemia parameters in patients with adenomyosis after 6 months of treatment. METHODS: This retrospective longitudinal observational cohort study included 162 women diagnosed with adenomyosis at İzmir Buca Seyfi Demirsoy Training and Research Hospital between 2020 and 2025. A total of 89 patients received LNG-IUS (Mirena), and 73 were treated with DNG 2 mg/day. Hemoglobin (Hb), neutrophil, lymphocyte, and platelet counts were obtained before treatment (baseline) and at 6 months to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Statistical analyses were performed using SPSS 27.0, with P  0.05). At 6 months, hemoglobin levels increased significantly more in the LNG-IUS group compared with the DNG group (2.29 ± 3.61 vs. 0.84 ± 4.82; P = 0.035). No significant differences were observed between groups in neutrophil, lymphocyte, platelet counts, or inflammatory indices (NLR, PLR, SII) before and after treatment (P > 0.05). CONCLUSION: Both LNG-IUS and DNG are safe and effective medical options for adenomyosis management. LNG-IUS provided superior improvement in hemoglobin levels and bleeding control, while neither treatment significantly altered systemic inflammatory indices. These findings suggest that inflammation in adenomyosis is largely confined to the local uterine environment and that hematologic markers such as NLR, PLR, and SII may have limited sensitivity in reflecting short-term therapeutic response.