Abstract:

Objective As a primary solution to the adenomyosis，the levonorgestrel⁃releasing intrauterine system（LNG⁃IUS）is clinically vitiated for its high rate of expulsion/downward displacement. This study aimed to study the expulsion/malposition rate，effectiveness，and side effects by modifying the LNG ⁃ IUS and anchoring it into the myometrium. Methods A total of 41 patients with adenomyosis who had LNG⁃IUS downward displacement/ expulsed visiting our hospital January 2014 to March 2018 were enrolled as the experimental group and treated with the modified LNG⁃IUS，while another 41 patients during the same period，as the control group，were treated with LNG⁃IUS after GnRH⁃α treatment. Results Among the experiment group，the modified system in 2 patients were expulsed respectively at months 12 and 18 after anchoring，with a total expulsion rate of 4.9% in 36 months. In the control group the total expulsion rate was 19.5%，with significant difference between the groups（χ2 = 4.100， P = 0.043）. In the experiment group，the LNG ⁃ IUS positions in the 39 patients without expulsion were properly fixed in uterus without ectopic displacement and infection during observation period. As compared with pretreat⁃ ment，the differences of both groups were statistically significant within one year treatment in terms of the degree of dysmenorrhea（VRS score），menstrual volume（PBAC score），uterine volume and hemoglobin（all P > 0.05）. Conclusion The Modified LNG⁃IUS is safe，effective，economical and simple in reducing the rate of LNG⁃IUS expulsion/downward displacement in adenomyosis patients with expulsion or malposition of LNG⁃IUS

Key words:

levonorgestrel?releasing intrauterine system, expulsion rate, adenomyosis