Menstrual Pattern Modulation Following Levonorgestrel Intrauterine System Use in Symptomatic Adenomyosis Patients

Abstract

Background: Adenomyosis is a chronic gynecological condition characterized by dysmenorrhea and heavy menstrual bleeding that
significantly affects reproductive-aged women. Conservative management strategies that preserve fertility have gained attention due
to limitations associated with surgical treatment. The levonorgestrel-releasing intrauterine system has emerged as an effective
therapeutic option by delivering localized progestin effects within the uterus. Objective: To evaluate menstrual pattern modulation
following levonorgestrel intrauterine system use among symptomatic adenomyosis patients. Methods: A quasi-experimental study
was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from August 2023 to July 2024. Thirty women aged 25–
45 years with symptomatic adenomyosis were enrolled. Baseline clinical assessment, transvaginal ultrasonography, hemoglobin
estimation and visual analog scale scoring were performed. LNG-IUS was inserted during days 5–7 of the menstrual cycle and
participants were followed at 3 and 6 months. Statistical analysis was performed using SPSS version 27 with a paired t-test and
McNemar test. Results: The mean age of participants was 36.17 ± 5.46 years. Heavy menstrual bleeding decreased from 50% at
baseline to 7.14% at the third month and was absent by the sixth month. Normal menstrual flow increased progressively; while
spotting and amenorrhea became more common during follow-up. Intermenstrual bleeding declined over time, indicating
stabilization of menstrual patterns. Conclusion: LNG-IUS effectively modulates menstrual patterns and reduces heavy menstrual
bleeding in women with adenomyosis, supporting its role as a conservative and fertility-preserving treatment option.