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Background <p>Abnormal uterine bleeding (AUB) is a common gynecological condition with a significant impact on women’s quality of life and public health. Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective first-line treatment, a subset of women ultimately require hysterectomy. The demographic, clinical, ultrasonographic, and histopathological factors associated with LNG-IUS treatment failure remain insufficiently understood.</p> Methods <p>This retrospective descriptive study included 233 women diagnosed with AUB who underwent LNG-IUS (Mirena<sup>®</sup>) insertion between November 2019 and December 2022 at a tertiary referral center. Patients were divided into two groups according to hysterectomy status during follow-up. Demographic data, PALM–COEIN classification, ultrasonographic findings, and histopathological results were analyzed.</p> Results <p>Of the 233 women, 60 (25.7%) underwent hysterectomy due to treatment-resistant bleeding, while 173 (74.2%) were managed successfully without surgery. Women in the hysterectomy group were significantly older than those in the non-hysterectomy group (median age 45.35 vs. 41.76 years, <i>p</i> = 0.001). Body mass index and parity did not differ significantly between groups. Structural uterine pathology was present in 92% of patients who required hysterectomy. Leiomyoma was the most common histopathological finding (38.3%), followed by adenomyosis (21.7%). Combined pathologies, including adenomyosis with leiomyoma or endometrial polyps, were also frequent. By contrast, most women in the non-hysterectomy group had no identifiable structural uterine abnormalities.</p> Conclusion <p>The effectiveness of the LNG-IUS in AUB management is strongly influenced by underlying structural uterine pathology. Leiomyoma and adenomyosis, particularly when coexisting, are major predictors of treatment failure and subsequent hysterectomy. Careful pre-treatment evaluation and individualized counseling are essential to optimize patient selection and treatment outcomes.</p>

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Factors associated with hysterectomy after failure of levonorgestrel-releasing intrauterine system treatment in women with abnormal uterine bleeding

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月16日

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  • Neslihan Erkal,
  • Metin Kaba,
  • Kevser Erdoğan,
  • Fatma Elif Işık Eryılmaz,
  • Zekiye Sivri,
  • Yeliz Akpınar Mayır

摘要

Background

Abnormal uterine bleeding (AUB) is a common gynecological condition with a significant impact on women’s quality of life and public health. Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective first-line treatment, a subset of women ultimately require hysterectomy. The demographic, clinical, ultrasonographic, and histopathological factors associated with LNG-IUS treatment failure remain insufficiently understood.

Methods

This retrospective descriptive study included 233 women diagnosed with AUB who underwent LNG-IUS (Mirena®) insertion between November 2019 and December 2022 at a tertiary referral center. Patients were divided into two groups according to hysterectomy status during follow-up. Demographic data, PALM–COEIN classification, ultrasonographic findings, and histopathological results were analyzed.

Results

Of the 233 women, 60 (25.7%) underwent hysterectomy due to treatment-resistant bleeding, while 173 (74.2%) were managed successfully without surgery. Women in the hysterectomy group were significantly older than those in the non-hysterectomy group (median age 45.35 vs. 41.76 years, p = 0.001). Body mass index and parity did not differ significantly between groups. Structural uterine pathology was present in 92% of patients who required hysterectomy. Leiomyoma was the most common histopathological finding (38.3%), followed by adenomyosis (21.7%). Combined pathologies, including adenomyosis with leiomyoma or endometrial polyps, were also frequent. By contrast, most women in the non-hysterectomy group had no identifiable structural uterine abnormalities.

Conclusion

The effectiveness of the LNG-IUS in AUB management is strongly influenced by underlying structural uterine pathology. Leiomyoma and adenomyosis, particularly when coexisting, are major predictors of treatment failure and subsequent hysterectomy. Careful pre-treatment evaluation and individualized counseling are essential to optimize patient selection and treatment outcomes.