OC148: Adenomyosis: sonographic findings before and after insertion of levonorgestrel intrauterine system

Recently it has been reported that a levonorgestrel intrauterine system (LNG-IUS) could be an effective and safe method in the treatment of adenomyosis. The aim of this study was to assess whether the sonographically detectable morphological alterations of the myometrium induced by adenomyosis changed after insertion of the LNG-IUS. Twenty premenopausal symptomatic (menorrhagia, severe dysmenorrhea) patients with sonographic findings typical of adenomyosis were enrolled into the study. Before and at least 6 months after insertion of the LNG-IUS all the patients underwent detailed transvaginal sonography which evaluated uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, thickness of uterine wall and asymmetric myometrium, presence of myometrial hyperechoic striation, presence of fibroids or adenomyomas and vascularization of the myometrial lesions. A comparison between dimensions and presence of these different signs of adenomyosis before and after insertion of the LNG-IUS was performed. Eleven patients become amenorrhoic and the other patients had a significant reduction in menstrual bleeding. Dysmenorrhea was completely relieved or significantly alleviated in all patients. We observed a significant decrease in uterine volume (785.3 ± 232.8 mL vs. 522.6 ± 166.1 mL) and reduction in asymmetric wall thickness (37.4 ± 5.8 mm vs. 29.2 ± 5.6 mm). However sonographic signs of adenomyosis such as myometrial cystic areas and hyperechoic striation did not disappear; some decreased in size but not significantly. After insertion of a LNG-IUS in patients with adenomyosis, uterine volume decreased, the myometrial wall shrank and symptoms were significantly alleviated. However sonographic signs of adenomyosis did not seem to disappear completely. LNG-IUS seems to be an effective prolonged therapy for symptoms but not a cytoreductive treatment for adenomyosis.