Levonorgestrel-Releasing Intrauterine System Improves Menorrhagia-Related Quality of Life in Patients with Symptomatic Adenomyosis

Levonorgestrel-releasing intrauterine system (LNG-IUS) relieves dysmenorrhea and heavy menstrual bleeding (HMB) in adenomyosis. However, its efficacy on health-related quality of life (HR-QOL) in patients with symptomatic adenomyosis remains unclear. The menorrhagia multi-attribute scale (MMAS), which measures HR-QOL improvement through the treatment of HMB, has never been used for evaluating menorrhagia-specific HR-QOL in patients with symptomatic adenomyosis. Hence, this study aimed to investigate the efficacy of LNG-IUS in improving menorrhagia-specific HR-QOL in these patients using the MMAS. The participants were diagnosed by magnetic resonance imaging. We also assessed the relationships between menorrhagia-specific HR-QOL, blood hemoglobin levels, and the degree of dysmenorrhea before and during LNG-IUS treatment. The LNG-IUS treatment improved the menorrhagia-specific HR-QOL more effectively in incipient type adenomyosis than in advanced type adenomyosis. The efficacy of LNG-IUS treatment on dysmenorrhea evaluated by the visual analog scale score tended to be better in the incipient type than in the advanced type. By the treatment of LNG-IUS, the blood hemoglobin level was not improved in the advanced type but in the incipient type. Furthermore, dysmenorrhea and HMB-related anemia were associated with HR-QOL impairment, and LNG-IUS treatment may improve the HR-QOL by relieving the symptoms. In conclusion, the effectiveness of LNG-IUS on HR-QOL is decreased by advanced adenomyosis. Thus, magnetic resonance imaging use should be reinforced to predict LNG-IUS efficacy in improving the HR-QOL of patients with adenomyosis. Similar content being viewed by others Data Availability The data and material underlying this article will be available upon reasonable request from the corresponding author. Code Availability Not applicable.

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Funding This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI (grant Nos. 19H03144 and 19H03796) and Japan Agency for Medical Research and Development (AMED) Whole Implementation to Support and Ensure the Female Life (WISE) (grant Nos. JP21gk0210021 and JP21gk0210028). Author information Authors and Affiliations Contributions Y.H. contributed to the conception and design of the study. C.I. contributed to the acquisition of data. C.I. and Y.H. analyzed the data. All authors were involved in data interpretations. C.I. drafted the manuscript, which was edited by Y.H. All authors have approved the final manuscript. Corresponding author Ethics declarations Ethics Approval The study was approved by the Ethics Committee of The University of Tokyo (Registration no.:3128). Consent to Participate Not applicable. Consent for Publication Not applicable. Conflict of Interest The authors declare no competing interests. Rights and permissions Springer Nature or its licensor 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 Ishizawa, C., Hirota, Y., Iida, R. et al. Levonorgestrel-Releasing Intrauterine System Improves Menorrhagia-Related Quality of Life in Patients with Symptomatic Adenomyosis. Reprod. Sci. 30, 966–973 (2023). https://doi.org/10.1007/s43032-022-01077-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-022-01077-9