Safety and Efficacy of Hysteroscopic Suture Fixation of the Levonorgestrel- Releasing Intrauterine System in Women with an Expulsion History: A Prospective Cohort Study

Abstract Background The levonorgestrel-releasing intrauterine system (LNG-IUS) is an efficient contraceptive and nonsurgical treatment for gynecological conditions. However, its expulsion rates are concerning. In this study, we suggest the use of non-absorbable suture fixation through hysteroscopy to mitigate expulsions and evaluate the safety and outcomes of this procedure. Methods This study included 73 women (average age: 41.34 years) with a history of LNG-IUS expulsion who underwent hysteroscopic suture fixation of the LNG-IUS at Women’s Hospital, Zhejiang University School of Medicine, between August 2022 and August 2023. Postoperative assessment was conducted using electronic questionnaires at 1, 3, and 7 days, along with outpatient follow-ups and ultrasonography at 1, 3, 6, and 12 months. Results The day surgery team successfully performed 73 procedures with a mean duration of 37.81 ± 15.42 min, encountering no complications. Follow-up was conducted for an average of 183.56 days for all 73 patients. Among them, 70 underwent postoperative imaging examinations, primarily ultrasonography, with an average follow-up imaging time of 117.33 days. This study revealed low expulsion (4.29%) and downward-shift (7.14%) rates. The primary adverse reactions observed were irregular bleeding or spotting in 71.23% of cases and an increased vaginal discharge rate of 8.22%. Conclusion Hysteroscopic LNG-IUS suture fixation is safe and effective for reducing expulsion rates in women with a history of expulsion. However, this procedure is associated with higher rates of irregular postoperative bleeding and increased vaginal discharge.