P06.07: Conservative management of deep adenomyosis treated with a levonorgestrel‐releasing intrauterine system: a sonographic based triage

To evaluate the efficacy of a conservative sonographic based management of deep adenomyosis treated with a levonorgestrel-releasing intrauterine system (LNG-IUS). Sixteen patients observed at a second level sonographic office for abnormal uterine bleeding and/or admitted for menometrorrhagia and/or severe anemia with dysmenorrea and/or dyspareunia were recruited. All patients underwent transvaginal sonography (TVS) with power-Doppler evaluation and sonohysterography (SHG) (Technos MP, Esaote, Italy). Deep adenomyosis was diagnosed in presence of an enlarged uterus, with inhomogeneous and thickened myometrium and/or with focal honeycomb lesions highly and irregularly vascularized at TVS. SHG was performed with a 4.7 mm intrauterine catheter. At the end of SHG, an endometrial sampling (SHGes) was performed by a syringe vacuum aspiration for a pathologic report. A LNG-IUS was then inserted with an immediate sonographic control. A sonographic follow-up at 3, 6, 12 and every 6 months was proposed. Mean age (+−sd) was 42 years +−7. Twelve patients presented diffuse adenomyosis and four focal lesions. Simple endometrial hyperplasia at SHGes was diagnosed in three patients (19%). Concerning LNG-IUS, one patient removed the device for persisting pelvic pain and in three cases a continuous oral contraceptive therapy was prescribed for persisting spotting. At a median follow-up of 15 months (interquartile range 12–24), no patient needed surgery. A conservative sonographic based triage for the management of deep adenomyosis with a levonorgestrel-releasing intrauterine system (LNG-IUS) treatment proved to be efficacious. This triage should be proposed to selected patients within a variety of medical options and before surgical treatments.