[Hemodynamic and clinical effects of the levonorgestrel-releasing intrauterine system in symptomatic adenomyosis: A prospective Doppler ultrasound study]

OBJECTIVES: To evaluate clinical, hematological, and uterine hemodynamic outcomes after levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women with symptomatic adenomyosis associated with heavy menstrual bleeding. METHODS: This prospective observational study included premenopausal women aged≥30 years with sonographically diagnosed adenomyosis based on recognized sonographic features consistent with descriptors later formalized in the revised MUSA consensus statement. Menstrual blood loss assessed by the Pictorial Blood Loss Assessment Chart (PBAC), pain severity assessed by Visual Analog Scale (VAS), hematological parameters, uterine volume, and uterine artery Doppler indices - including resistance index (RI) and pulsatility index (PI) - were evaluated before LNG-IUS insertion and after 12 months of follow-up. Pre- and post-treatment comparisons were performed using paired statistical tests. RESULTS: Sixty-five patients completed the 12-month follow-up. PBAC scores decreased significantly (169.6±49.6 vs. 42.4±20.6; P<0.001) as did VAS pain scores (4.2±1.8 vs. 2.4±0.8; P<0.001). Hemoglobin and hematocrit levels increased significantly (P<0.001). A significant reduction in uterine volume was observed (161.3±33.5mL vs. 123.0±28.0mL; P<0.001). Uterine artery PI values did not change significantly, whereas RI values increased significantly on both sides (P<0.001). No significant correlations were identified between RI changes, PBAC score reduction, and uterine volume reduction. Amenorrhea occurred in 21.5% of patients at 12 months. No cases of pelvic inflammatory disease or ovarian cyst formation were observed. CONCLUSIONS: In women with symptomatic adenomyosis, LNG-IUS treatment is associated with significant clinical and hematological improvement together with reduction in uterine volume at 12 months. The observed increase in uterine artery resistance indices suggests that hemodynamic alterations may contribute to bleeding reduction in addition to endometrial suppression, although this relationship remains exploratory. LNG-IUS appears to be an effective, well-tolerated, and uterus-preserving treatment option for symptomatic adenomyosis.