Treatment of symptomatic adenomyosis with the levonorgestrel‐releasing intrauterine system

Objective To determine the long‐term effects of using the levonorgestrel‐releasing intrauterine system ( LNG ‐ IUS ) to treat symptomatic adenomyosis. Method A prospective longitudinal study was conducted among 1100 women who received the LNG ‐ IUS at a tertiary teaching hospital in China between December 10, 2006, and December 24, 2014. All participants had symptomatic adenomyosis (visual analogue scale [ VAS ] ≥7 and/or pictorial blood loss assessment chart [ PBAC ] score >100) diagnosed by transvaginal sonography. Follow‐up was at 3, 6, 12, 24, 36, 48, and 60 months after LNG ‐ IUS placement. The primary outcome was symptom relief. Secondary outcomes included LNG ‐ IUS retention status; changes in uterine volume; serum levels of cancer antigen 125 ( CA 125); menstruation pattern; and adverse events. Results In all, 374 (33.7%) participants completed 60 months of LNG ‐ IUS treatment. The VAS , verbal rating scale, PBAC score, hemoglobin level, uterine volume, and serum CA 125 level all showed marked improvements at this time point when compared with baseline ( P <0.05 for all comparisons). The cumulative retention rate of LNG ‐ IUS was 56.2%. Changes in menstruation pattern at 60 months included amenorrhea (n=97, 25.9%) and shortened periods (n=82, 21.9%). The incidence of adverse events was <10% and not considered notable. Conclusions Long‐term use of LNG ‐ IUS was effective and acceptable for the treatment of symptomatic adenomyosis. Registered at clinicaltrials.gov ( NCT 03027648).