Comparison of combined transcervical resection of the endometrium and levonorgestrel-containing intrauterine system treatment versus levonorgestrel-containing intrauterine system treatment alone in women with adenomyosis: a prospective clinical trial.

To compare the effect of transcervical resection of the endometrium (TCRE) combined with levonorgestrel-containing intrauterine system (LNG-IUS) versus LNG-IUS alone in the treatment of adenomyosis.A total of 43 patients with adenomyosis, suffering from dysmenorrhea and menorrhagia, were recruited. Twenty patients underwent TCRE first followed by insertion of the LNG-IUS (group 1), while 23 patients were managed with the LNG-IUS alone (group 2). Both groups were followed up at 3, 6 and 12 months with regard to menstrual characteristics. Visual analogue scores, transvaginal ultrasound scans and routine gynecological examinations were performed on all patients during the follow-up visits.There was a significant reduction in menstrual flow and pain in both groups following treatment. The reduction in menstrual flow in group 1 was significantly (p < 0.001) greater than that of group 2 at 3, 6 and 12 months posttreatment. On the other hand, there was no significant difference (p = 0.061) in the reduction of pain between the two groups.TCRE combined with LNG-IUS for the treatment ofadenomyosis is more effective in reducing menstrual flow compared with the LNG-IUS alone. However, there was no demonstrable difference in the amount of pain reduction between the two treatment strategies.