Abstract
Background: Adenomyosis is a benign uterine condition causing heavy menstrual bleeding, dysmenorrhea, and reduced quality of life (QoL). Hysterectomy is definitive treatment, whereas the levonorgestrel-releasing intrauterine system (LNG-IUS) offers a less invasive, uterus-preserving alternative.
Objective: To compare the efficacy and QoL outcomes of LNG-IUS and hysterectomy in women with adenomyosis.
Methods: This descriptive case series was conducted over six months in Unit II, Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore. Sixty women aged 30–50 years with adenomyosis were enrolled using non-probability consecutive sampling and equally assigned to LNG-IUS (n=30) or hysterectomy (n=30). Primary outcomes were patient satisfaction and control of heavy menstrual bleeding at six months.
Results: Baseline characteristics were similar between groups. At six months, satisfaction was significantly higher in the hysterectomy group (96.7%) versus LNG-IUS (66.7%) (p=0.002). Persistent heavy bleeding occurred in 30.0% of LNG-IUS users and none in the hysterectomy group (p=0.003). Subgroup analysis showed lower satisfaction and higher bleeding rates among LNG-IUS users aged 40–50 years, with BMI ≥28 kg/m², or adenomyoma size >3.5 cm (p<0.05).
Conclusion: Hysterectomy offers superior bleeding control and satisfaction for adenomyosis. LNG-IUS remains a viable alternative, especially for younger women with lower BMI and smaller adenomyomas. Careful patient selection is essential to optimize outcomes.
Keywords: Adenomyosis; LNG-IUS; hysterectomy; heavy menstrual bleeding; patient satisfaction; quality of life