Clinical application of a simplified hysteroscopic LNG-IUD non-suture fixation in the treatment of adenomyosis

Background Placement of a levonorgestrel-releasing intrauterine device (LNG-IUD) is an effective treatment forpatients diagnosed with adenomyosis who had a strong desire to preserve the uterus and had no immediate fertility requirements. However, there are also some limitations to the suitability of the LNG-IUD for women with adenomyosis, as adenomyosis causes distortion or enlargement of the uterine cavity. Therefore, the LNG-IUD is more prone to expulsion in patients with adenomyosis. In this study, we aimed to show an original and simplified approach using the hysteroscope for non-suture fixation of LNG-IUD in patients with adenomyosis. Methods In this retrospectivecase series approved by the Ethics Committee of Obstetrics and Gynecology Hospital of Fudan University, sixty-two patients diagnosed with adenomyosis who had a strong desire to preserve the uterus and had no immediate fertility requirements in the short term were included in the study. They underwent hysteroscopic non-suture fixation of LNG-IUD. All patients underwent one-year postoperative follow-up to evaluate the LNG-IUD expulsion rate, postoperative efficacy and side effects. Results Sixty-two patients with adenomyosis underwent non-suture fixation with LNG-IUD and during the long-term postoperative follow-up, every patient experienced complete remission of their symptoms: a significant decrease in menstrual flow, relief of dysmenorrhea, and improvement in quality of life. Only two patients experienced expulsion of the LNG-IUD at 6 months and 10 months postoperatively, respectively. Conclusions Hysteroscopic non-suture fixation of the LNG-IUD can be a more simplified and minimally invasive alternative treatment for patients with a history of LNG-IUD expulsion. The non-suture method greatly reduces the complexity of hysteroscopic fixation and can be performed more efficiently in office.