Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

AIM: The levonorgestrel‐releasing intrauterine (LNG‐IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system—allowing affixion to the myometrium—and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding. METHODS: This study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG‐IUS (experimental group, n = 47); and the original system after gonadotropin‐releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016. RESULTS: In the experimental group, two device expulsions occurred 12–18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60‐month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5‐year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm(3)), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups). CONCLUSIONS: Use of the modified LNG‐IUS is a safe, cost‐effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding.