Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system

Adenomyosis is an important cause of menorrhagia. Besides hysterectomy, the treatment options for adenomyosis have been limited. Presented here is the successful treatment of adenomyosis in a woman presenting with menorrhagia, dysmenorrhea, and an enlarging uterus, for whom conservative therapy initiated with mefenamic acid was unsatisfactory. The patient had insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS). A marked decrease in uterine size occurred within 12 months of insertion accompanied by resolution of the menorrhagia and dysmenorrhea. Thus, the LNG-IUS is a viable option and represents a real advance in the treatment of adenomyosis.Adenomyosis is the major cause of menorrhagia, dysmenorrhea, and an enlarged uterus, which causes great distress to the patient. Surgical hysterectomy has been used in the past as a treatment option for adenomyosis, but acceptability of this intervention is minimal due to an increased risk in morbidity and mortality. This article presents the successful medical treatment of an enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system (LNG-IUS) using a case report of a 42-year-old woman with adenomyosis who received the LNG-IUS as a long-term therapy for menorrhagia and dysmenorrhea. Regular menstruation without pain was reported after 3 months of treatment with a 27% decrease in uterine size after 9 months. The effectiveness of the LNG-IUS was hypothesized to be due to two factors: 1) decidualization and subsequent marked atrophy of the endometrium; 2) direct action of the hormone on the foci of the adenomyosis. A reported side effect of the LNG-IUS is the irregularity of bleeding during the initial treatment. The study suggests that use of the LNG-IUS is a viable option and could greatly advance the treatment of adenomyosis.