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Published on: September 12, 2025
Levonorgestrel Intrauterine Device versus Combined Transcervical Resection of the Endometrium in the Management of
Murali Subbaiah1, Yavana Suriya2, Nevetha Selvarajan1
1Department of Obstetrics and Gynaecology, JIPMER, Puducherry, Tamil Nadu, India.
Objectives:
To compare the treatment failure rates in patients with adenomyosis who underwent transcervical resection of the endometrium (TCRE) and levonorgestrel intrauterine device (LNG-IUD) insertion versus those with LNG-IUD insertion alone.
Materials And Methods:
One hundred and forty-six women with adenomyosis and heavy menstrual bleeding (HMB) or dysmenorrhea were enrolled in this randomized controlled clinical trial (CTRI/2020/09/027592). One group had TCRE with LNG-IUD insertion and the other group had only LNG-IUD insertion. Baseline assessment included quality of life score (World Health Organisation quality of life-BREF [WHO QOL-BREF]), and menorrhagia multi-attribute scale (MMAS) score. The patients in both the treatment arms were followed up for 12 months. The scores were reassessed at 12 months along with LNG-IUD expulsion rates and treatment failure, which included any of the following: hysterectomy for adenomyosis, persistent HMB, or persistent dysmenorrhea.
Results:
The primary outcome of treatment failure was significantly lower in the TCRE + LNG-IUD group (7.14% vs. 25%, P = 0.01; Risk ratio 3.45, 95% Confidence interval (1.35-8.83). The quality-of-life (WHO QOL-BREF) and MMAS scores at 12 months were also significantly better in the TCRE + LNG-IUD arm. None of the women in the combined TCRE and LNG-IUD group had LNG-IUD expulsion at 12 months compared to the LNG-IUD expulsion rate of 8.8% in the LNG-IUD alone group (P = 0.013).
Conclusion:
A combination of TCRE with LNG-IUD had a lower failure rate at 12 months in women with adenomyosis compared to LNG-IUD alone. This combination also resulted in better quality of life and lowered the chance of LNG-IUD expulsion at 12 months.
