Levonorgesterel releasing intra uterine system in the control of heavy menstrual bleeding. Is it an alternative to hysterectomy?

Sobha S. Nair, Jayashree Nayar, Ann John Kurien, Isha Seth
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(11) , pp. 4448 · doi:10.18203/2320-1770.ijrcog20194873 · W2981591379
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⚙ AI-generated summary by claude@2026-07, 2026-07-28 ⓘ

The levonorgestrel-releasing intrauterine system (LNG-IUS) effectively controls heavy menstrual bleeding, improves quality of life, and reduces uterine volume in adenomyosis and endometrial hyperplasia, offering an alternative to hysterectomy.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This retrospective 2-year study from a tertiary care center enrolled 170 women with abnormal uterine bleeding, evaluating clinical findings, imaging, and endometrial sampling when indicated, then assessing outcomes after levonorgestrel-releasing intrauterine system (LNG-IUS) use. Among participants (mean age 41), 44% had adenomyosis and 19.4% had endometrial hyperplasia; follow-up losses occurred in 12.9% of cases, and device expulsion was reported in 3.6%. The authors found a high satisfaction rate (97%), with significant reductions in uterine width in adenomyosis and in endometrial thickness in endometrial hyperplasia, and they reported complete regression of endometrial hyperplasia with LNG-IUS, while 4.1% ultimately underwent hysterectomy; a key limitation explicitly noted by the study design is the retrospective nature and the loss to follow-up. This paper is centrally about endometriosis and adenomyosis — it reports LNG-IUS effectiveness for symptomatic control in women with adenomyosis.

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Abstract

Background: Heavy menstrual bleeding (HMB) affects 10 to 35% of women. Studies indicate LNG-IUS which releases controlled amounts of levonorgestrel (LNG) is effective in non- surgical treatment for HMB and has fewer side effects when compared to the conventional pharmacological agents. It also improves the quality of life. Levonorgesterel releasing intra uterine system can be an alternative to hysterectomy in the control of HMB.Methods: Retrospective study of 2 years in a tertiary care centre, Kochi. 170 women with abnormal uterine bleeding were enrolled in the study. Clinical examination, routine investigations and imaging was done. Endometrial sampling done and followed with HPE reports in indicated cases.Results: Mean age was 41 years. 30.6% had menorrhagia. Adenomyosis in 44% and endometrial hyperplasia in 19. 4%. Lost follow up in 12.9% cases and expulsion in 3.6%. 4.1% were unsatisfied and had hysterectomy. The uterine width in adenomyosis was significantly reduced p <0.012. The mean ET in endometrial hyperplasia cases also significantly reduced with p <0.01. Satisfaction rate was 97%.Conclusions: LNG-IUS is having a high success rate in controlling menstrual symptoms, thereby improving the quality of life and avoiding hysterectomy in women with abnormal uterine bleeding. It is highly efficient in symptomatic relief of adenomyosis and reduction in the uterine volume (width). Endometrial hyperplasia showed complete regression with LNG-IUS.
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Background

Heavy menstrual bleeding (HMB) affects 10 to 35% of women. Studies indicate LNG-IUS which releases controlled amounts of levonorgestrel (LNG) is effective in non- surgical treatment for HMB and has fewer side effects when compared to the conventional pharmacological agents. It also improves the quality of life. Levonorgesterel releasing intra uterine system can be an alternative to hysterectomy in the control of HMB.

Methods

Retrospective study of 2 years in a tertiary care centre, Kochi. 170 women with abnormal uterine bleeding were enrolled in the study. Clinical examination, routine investigations and imaging was done. Endometrial sampling done and followed with HPE reports in indicated cases.

Results

Mean age was 41 years. 30.6% had menorrhagia. Adenomyosis in 44% and endometrial hyperplasia in 19. 4%. Lost follow up in 12.9% cases and expulsion in 3.6%. 4.1% were unsatisfied and had hysterectomy. The uterine width in adenomyosis was significantly reduced p <0.012. The mean ET in endometrial hyperplasia cases also significantly reduced with p <0.01. Satisfaction rate was 97%.

Conclusions

LNG-IUS is having a high success rate in controlling menstrual symptoms, thereby improving the quality of life and avoiding hysterectomy in women with abnormal uterine bleeding. It is highly efficient in symptomatic relief of adenomyosis and reduction in the uterine volume (width). Endometrial hyperplasia showed complete regression with LNG-IUS. Metrics

References

Sharma A, Dogra Y. Trends of AUB in tertiary centre of Shimla hills. J Mid Life Health. 2013;4(1):67-8. Munro MG, Critchley HO, Broder MS. FIGO working group on menstrual disorders. FIGO classification system. (PALM-COEIN) for causes of AUB in non-gravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3-13. Bednarek PH, Jensen JT. Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS. Int J Womens Health. 2010;1:45-58. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Kisa Form-36 (KF36)’nin Turkce versiyonunun guvenilirligi ve gecerliligi. Ilac ve Tedavi Dergisi. 1999;12:102-10. Garg S, Soni A. A non-surgical lifeline for Abnormal uterine bleeding (AUB)-the LNG IUS. Ind J Obstet Gynecol Res. 2016;3(1):23-7. Dhamangaonkar PC, Anuradha K, Saxena A. Levonorgestrel intra uterine system (Mirena): an emerging tool for conservative treatment of abnormal uterine bleeding. J Midlife Health. 2015;6(1):26-30. Gupta T, Gupta N, Gupta S, Bhatia P, Jain J, Kumar S. Levonorgestrel intrauterine system (LNG IUS) in menorrahgia: a follow-up study. Open J Obstet Gynecol. 2014;4:190-6. Singh K, Bharati G, Prasad D, Kumari S. Role of levonorgestrel releasing intrauterine device in management of heavy menstrual bleeding: a conservative approach. Int J Repro Contra Obstet Gynecol. 2017;6(2):631-63. Eralil GJ. The effectiveness of LNG-releasing IUS in treatment of HMB. JOGI. 2016;66(S1):S505-12. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, et al. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med. 2015;3:14-23. Endrikat J, Vilos G, Muysers C. The levonorgestrel-releasing intrauterine system provides a reliable, long-term treatment option for women with idiopathic menorrhagia. Arch Gynecol Obstet. 2012;285:117-21. Morrow C, Naumburg EH. Dysmenorrhea. Prim Care. 2009;36:19-32. Gallos ID, Birmingham M, Professor TJ, Clark R, Faraj AN, Rosenthal PP. Endometrial hyperplasia, management of (green top guideline no. 67) joint guideline of RCOG/BSGE; 2017. Gallos ID, Krishan P, Shehmar M, Ganesan R, Gupta JK. LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: a long-term comparative cohort study. Human Repro. 2013;28(11):2966-71. Hashim HA, Zayed A, Ghayaty E, El Rakhawy M. LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial. J Gynecol Oncol. 2013;24:128-34. Ismail MH, Fahmy DM, Elshmaa NS. Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia. Reprod Sci. 2013;20:45-50.

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