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Background: Treatment for patients with symptomatic adenomyosis has been mainly by hysterectomy. The aim of this 5-year observational study was to assess the feasibility of Hysteroscopic Endomyometrium Resection with concomitant Insertion of Levonorgestrel-Releasing Intrauterine Device for symptomatic adenomyosis.

Methods: From May 2015 and December 2022, a group of 36 women with symptomatic adenomyosis underwent this combined modality treatment at a community hospital. The core outcomes of the study were effective rate of dysmenorrhea, menorrhagia, secondary outcomes as hysterectomy, Intrauterine device expulsion, or premature removal, repeated the procedures.

Results: The study followed the progress of 36 women, aged 42.9±4, over a period of five years. The procedures were performed safely, and no complications were observed. The total successful rate of amenorrhea was 27 of 36 (75%). For the Pain Control, the intervention led to a significant reduction in pain scores, with the mean pain score decreasing by approximately 63.4% (95% CI: -64.3% to -62.5%). For the Blood Loss, with the mean blood loss decreasing by approximately 75.77% (95% CI: 32.93% to 118.61%). The study also showed reduced CA-125 level, reduction in uterine length and volume, about 70% of patients reported being very satisfied and satisfied of this combined treatment.

Conclusion: In this study, we not only confirmed the five-year effectiveness of Transcervical endomyometrium resection combining with Levonorgestrel-Releasing Intrauterine Device in treating symptomatic adenomyosis, achieving a high rate of amenorrhea and patient satisfaction in women wishing to preserve their uterus, but we also identified a need for additional measures to reduce menstrual flow during the initial six months following treatment. We demonstrated this combined modality is feasible and safe for treatment of symptomatic adenomyosis.