Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis

ObjectiveTo compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL).DesignProspective randomized clinical trial.SettingWomen’s health teaching and research hospital.Patient(s)Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study.Intervention(s)Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy.Main Outcome Measure(s)Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment.Result(s)LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased.Conclusion(s)It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.