Role of Levonorgestrel Medicated Intrauterine Device in Adenomyosis

Abstract

Adenomyosis is a benign, estrogen-dependent gynecological disorder characterized by the invasion of endometrial glands and stroma into the myometrium, leading to menorrhagia, dysmenorrhea, and infertility. Despite its prevalence, the etiology remains unclear. Conventional treatments such as hysterectomy, uterine artery embolization, and high-intensity focused ultrasound (HIFU) are effective but may not preserve fertility. Therefore, medical management is often preferred, with hormonal therapies playing a central role. The levonorgestrel-releasing intrauterine system (LNG-IUS) has emerged as a highly effective, minimally invasive treatment option. It continuously releases 20 µg/day of levonorgestrel, exerting localized effects on the endometrium and myometrium. The mechanism involves decidualization and atrophy of the endometrium, suppression of estrogen receptors, and reduction of prostaglandin production, which collectively alleviate pain and reduce menstrual bleeding. Numerous clinical studies confirm that LNG-IUS significantly decreases uterine volume, menstrual blood loss, and dysmenorrhea severity over long-term use, with a favorable safety profile compared to systemic hormonal therapies. Adverse effects are generally mild and transient, including irregular bleeding and hormonal symptoms. Overall, the LNG-IUS not only provides effective contraception but also serves as an efficient therapeutic option for adenomyosis, improving patients’ quality of life and avoiding more invasive procedures. Future research should further assess its long-term outcomes and potential role in combination therapies for optimal symptom control and uterine preservation.