The suture fixation of levonorgestrel-releasing intrauterine device in the treatment of adenomyosis: A case report

INTRODUCTION: The report on Levonorgestrel⁃releasing intrauterine system (LNG⁃IUS) suture under hysteroscopy is very rare, and currently only three articles have been reported. We reported a patient with adenomyosis who had previously had LNG-IUS, but the LNG-IUS moved downward. We sutured and fixed the LNG-IUS under hysteroscopy. CASE PRESENTATION: A 42-year-old woman presented with a 7-year history of adenomyosis of the uterus and adenomyoma adenomyosis. Half a year ago, due to increased menstrual flow, LNG-IUS was placed in the uterine cavity, and the treatment effect was satisfactory. Nine days ago, vaginal bleeding occurred, and ultrasound showed that LNG-IUS had moved downward. We performed LNG-IUS suturing under hysteroscopy for her, and a half-year follow-up ultrasound showed that the position of LNG-IUS was normal. CLINICAL DISCUSSION: For adenomyosis, LNG-IUS is the most promising medical therapy due to its ability to suppress hormones to improve symptoms with a low profile of adverse effects while enabling women to maintain fertility. However, the high excretion rate of LNG-IUS may cause patients with adenomyosis to lose confidence in continuing to use this treatment method. CONCLUSION: Our case report demonstrated the feasibility and effectiveness of LNG-IUS suture fixation under hysteroscopy. It provided another reliable treatment option for those patients with adenomyosis for whom the LNG-IUS fell off or fell down.