Abstract
Case: A 43-year-old woman (gravida 1, para 1) presented to our clinic requesting termination of a 6-week pregnancy. Her medical history was significant for menorrhagia, dysmenorrhea who was treated by transcervical resection of the endomyometrium (TCREM) followed by the immediate insertion of a levonorgestrel-releasing intrauterine device (LNG IUS) 7 years previously.
Introduction: Treating adenomyosis in women who wish to preserve their uterus remains a challenging task. TCREM followed by the immediate insertion of LNG IUS is rarely reported.
Objective: To provide an updated analysis of this combined treatment as an alternative treatment for adenomyosis.
Mechanism: High local levels of LNG from the LNG IUS downregulate estrogen receptors in the endomyometrium, leading to tissue atrophy and thereby preventing further estrogen stimulation.
Materials and Methods: A literature review was performed using PubMed, Google Scholar, and the Cochrane Library for studies addressing TCREM plus LNG-IUS for symptomatic adenomyosis published between January 2000 and December 2023.
Results: Three relevant papers were identified. One study reported a 12-month amenorrhea rate of 100% (p<0.001) post-intervention, with a 90% reduction in dysmenorrhea, while control groups had a 19% reintervention rate. The single-arm observational study with a 5-year follow-up found a 75% amenorrhea rate, reduced VAS score, blood loss, and uterine size (p<0.001, p<0.001, p=0.005, respectively), a hysterectomy reintervention rate of 6%, IUD expulsion in 8%, premature removal in 11%, and a 70% patient satisfaction rate. The case series report included 2 women with six months of follow-up; both reported light bleeding and no dysmenorrhea.
Conclusion: The combination therapy appears promising for treating symptomatic adenomyosis with high rates of amenorrhea and patient satisfaction. However, additional high-quality research is necessary due to the small sample size and methodological limitations in the current studies.