Use Of Levonorgestrel Intrauterine System Research Articles

Prevalence of high-risk HPV and cervical dysplasia in IUD users and controls: a cross sectional study

Objective To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. Methods A cross-sectional register-based study including 16,181 women aged 30–49 years participating in the screening programme for cervical cancer in a Swedish County in 2017–2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. Results There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04–1.41, and aOR 1.41; 95% CI 1.22–1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02–2.06, and aOR 1.56; 95% CI 1.13–2.16, respectively). No significant differences were found in HPV clearance rates. Conclusions Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

Exploring the Role of Levonorgestrel Intrauterine System (LNG-IUS) as a Method of Emergency Contraception (EC).

Copper T 380-A (CuT380A) intrauterine device (IUD) has been an effective method of emergency contraception (EC). Levonorgestrel intrauterine system (LNG-IUS) has not been approved by the Food and Drug Association for EC till now. There are few studies that provide data regarding the efficacy of LNG-IUS as EC. This systematic review tried to explore the efficacy of LNG-IUS in preventing accidental pregnancies up to five days of unprotected intercourse. A systematic review of the published studies on the use of LNG-IUS as EC was done. All randomized trials, prospective cohorts, retrospective cohorts. and case-control study designs pertaining to this topic were included in this review. Abstracts were retrieved and reviewed by two authors independently. Variables pertaining to socio-demographic parameters, EC use-related variables (reason for use, frequency, time elapsed since coitus), and those associated with sexual habits were selected and recorded. A total of six articles were rendered for the review. High school students and those attending college accounted for 36.8%-51.8% of the study population. Data on the reason for seeking EC showed noncompliance to routine contraception as the most common reason, followed by failure of withdrawal method, breach of barrier contraception, and unplanned intercourse. With a negligible failure rate, LNG-IUS seemed to be a good alternative to the existing copper EC. Considering the plethora of noncontraceptive benefits associated, LNG-IUS can be safely provided as an option of EC in the cafeteria approach within five days of unprotected intercourse.

A randomized controlled pilot study of ulipristal acetate for abnormal bleeding among women using the 52-mg levonorgestrel intrauterine system.

To assess the efficacy of ulipristal acetate (UPA) for reducing abnormal bleeding among women using the 52-mg levonorgestrel intrauterine system (LNG-IUS). A randomized, double-blind, placebo-controlled pilot study conducted from September 1, 2016 to September 30, 2018, at the University of Campinas, Brazil. LNG-IUS users reporting prolonged or frequent uterine bleeding for at least 1year were randomized to receive 5mg UPA per day for 5days or placebo at an identical regimen. Bleeding was recorded for 90days after treatment began and was compared between the groups. Of 94 eligible women, 64 with abnormal bleeding associated with LNG-IUS use declined treatment or device removal after counselling regarding anticipated bleeding patterns. For the 25 study participants, differences were nonsignificant between the UPA and placebo groups for number of days before bleeding stopped and days free of bleeding; however, UPA users displayed a trend for shorter duration before bleeding stopped and longer time free of bleeding. A similar trend for mean number of bleeding days at 30-, 60-, and 90-day follow-up was observed. A nonsignificant trend in reduction of abnormal bleeding was observed among LNG-IUS users taking 5mg UPA per day for 5days compared with placebo; however, further research is needed. CLINICALTRIALS.GOV: NCT03186586.

Levonorgestrel intrauterine contraceptive systems (13.5mg and 52mg) and risk of ectopic pregnancy.

The objective was to investigate the Pearl index for ectopic pregnancy in women using the levonorgestrel intrauterine system (LNG-IUS) at the time of conception. This was a substudy of a hospital-based historical cohort including women with an ectopic pregnancy diagnosed in 4 referral hospitals in Stockholm, Sweden between December 2013 and April 2017. Study participants and type of contraception at time of conception were identified through the electronic medical chart system. Cases were defined as women with LNG-IUS 13.5 or 52mg in situ at the time of diagnosis of ectopic pregnancy who had their LNG-IUS inserted 1 January 2014 or later. Outcome was defined as the incidence rate for ectopic pregnancy during use per 100 woman-years (Pearl index) with 95% confidence interval (95% CI). The study includes 35 cases with LNG-IUS 13.5mg and 13 cases with LNG-IUS 52mg, which occurred in 18488 (13.5mg) and 50246 (52mg) exposed woman-years. Pearl index for ectopic pregnancy was estimated at 0.19 (95% CI 0.15-0.28) for LNG-IUS 13.5mg and to 0.006 (95% CI 0.00-0.01) for LNG-IUS 52mg. The most cases for the LNG-IUS 13.5mg (n=26; 74%) occurred during the first year of use with a corresponding Pearl index at 0.23 (95% CI 0.14-0.35). The absolute risk of ectopic pregnancy during the use of LNG-IUS remains low. Our method may underestimate as well as overestimate the Pearl index for ectopic pregnancy. The findings underline the importance of identifying risk factors for ectopic pregnancy at insertion, and to rule out ectopic pregnancy for all women presenting with abdominal discomfort during the use of LNG-IUS. Longer observation periods and prospective studies in a general population are a priority for further research.

Is LNG-IUS the One-Stop Answer to AUB?

A systematic search of the literature available on the use of Levonorgestrel intra-uterine system (LNG-IUS) in women with abnormal uterine bleeding was done. This included PubMed searches up to February 2017 as well as references available with the authors. LNG-IUS usage in other situations was not included in the study. Each relevant published article was evaluated as to whether it served the purpose of this review. Available data show that LNG-IUS is certainly the one-stop answer to AUB, providing a safe and cost-effective treatment and being a substitute for hysterectomy in most women with AUB.

Effects of intrauterine contraception on the vaginal microbiota

ObjectivesThere have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. Study designDNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. ResultsThe vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. ConclusionsAlthough the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. ImplicationsWe found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered.

Long-Term Clinical Outcomes of Thermal Balloon Endometrial Ablation (Thermablate EAS) with and without Concomitant Use of Levonorgestrel Intra-Uterine System in Women with Heavy Menstrual Bleeding: A Pilot Study

Long-Term Clinical Outcomes of Thermal Balloon Endometrial Ablation (Thermablate EAS) with and without Concomitant Use of Levonorgestrel Intra-Uterine System in Women with Heavy Menstrual Bleeding: A Pilot Study

One year quality of life measured with SEC-QoL in levonorgestrel 52 mg IUS users

ObjectivesThe present study aims to prospectively evaluate quality of life (QoL) of women using 52-mg levonorgestrel intrauterine system (LNG-IUS) for contraception determined through the Sociedad Española de Contracepción (Spanish contraception Society) (SEC)-QoL, a questionnaire specifically designed to assess the impact of contraceptive methods on QoL of fertile women. Study designWe conducted a prospective observational multicenter study of 201 reproductive age women who initiated the LNG-IUS for contraception. Sociodemographic and clinical data were collected at baseline and 12months afterwards. Participants filled in the SEC-QoL questionnaire at both visits. SEQ-QoL scores range from 0 (worst QoL) to 100 (best QoL). ResultsParticipants claimed an increased QoL 12months after insertion in all five dimensions of SEC-QoL due to its high contraceptive efficacy and its capability to reduce other menstrual symptoms (e.g., heavy menstrual bleeding or dysmenorrhoea), overall exerting a positive impact on user's satisfaction. SEC-QoL general overall score went from a mean (S.D.) score of 46.3 (17.3) at baseline to 72.2 (14.8) 12months afterwards (p<.001). Overall, 94.6% of women claimed having found additional benefits other than contraception. No pregnancies were reported during the 12months of study duration, and only 14 women discontinued use of LNG-IUS (only two of them due to an adverse event), representing a continuation rate of 93%. ConclusionsWomen using LNG-IUS for contraception have an increased QoL after 12months of use, demonstrated by the increased score in all dimensions of the SEC-QoL questionnaire. ImplicationsThe present study prospectively evaluated QoL of women using LNG-IUS for contraception through the SEC-QoL questionnaire. Participants claimed increased QoL 12months afterwards, implying that women using LNG-IUS for contraception in usual clinical practise also benefit from the reduction of period-related symptoms, overall leading to very low discontinuation rates.

P06.07 The effects of contraception on the vaginal microbiota

Introduction The human microbiota plays important roles in immune system development and resistance to infection. However, factors that influence vaginal bacterial community composition and dynamics are not well understood. There have been conflicting reports of altered vaginal microbiota and infection susceptibility with contraception use. The objective of this study was to determine if contraception use altered the vaginal microbiota. Methods Vaginal swab samples were obtained from over 400 women during their first year of using hormonal contraception (levonorgestrel intrauterine system (LNG-IUS), depot medroxyprogesterone acetate (DMPA), combined oral contraceptive, contraceptive patch and etonogestrel implant) or a non-hormonal copper intrauterine device. Samples were obtained at baseline, 6 months and 12 months as part of the Contraceptive CHOICE study. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced with an Illumina MiSeq. The 16S rRNA gene sequences were processed and analysed using the software package mothur. After clustering the sequences into operational taxonomic units (OTUs) based on sequence similarity we calculated several ecological metrics including θYC distances (a metric that takes relative abundances of both shared and non-shared OTUs into account) between communities. Results The vaginal microbiota in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one more diverse community type. Initial analysis indicates differences between the microbiota at baseline and after LNG-IUS use. Additionally, specific OTUs were enriched with the use of certain contraceptive methods. For example, higher levels of 2 Prevotella OTUs were associated with DMPA use. Conclusion Alterations of the vaginal microbiota are associated with the use of certain contraceptives. Further studies and analysis will be needed to verify these findings and determine the implications for infection susceptibility. Disclosure of interest statement We did not receive any commercial contributions for this study.

Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception.

Is small uterine cavity size as assessed by ultrasonography associated with bleeding problems or pain in nulligravid women using intrauterine contraception, or do other factors affect these parameters? Among levonorgestrel intrauterine system (LNG-IUS) users, small uterine cavity size is not associated with worsened clinical outcome, but is beneficial as women with the smallest cavity measurements were frequently amenorrhoeic and painless at the end of the first year but among copper intrauterine device (IUD) users, no associations between uterine cavity dimensions and clinical outcome were found. Nulligravid and nulliparous women have smaller uterine dimensions than parous women. Previously, many studies have revealed increased discontinuation rates of IUD use as a result of bleeding, pain or expulsion in these women, while recent studies with current models of IUS/IUDs indicate similar continuation and satisfaction rates irrespective of parity. In a pilot study, 165 adult nulligravid women requesting their first IUD between 1 January 2011 and 31 July 2012 were given a free choice between two IUDs with equal frames measuring 32 × 32 mm-the LNG-IUS 52 mg or a copper-releasing IUD. The women were followed for 1 year. The LNG-IUS was chosen by 113 women (68.5%) and the copper IUD by 52 (31.5%). Prior to insertion the women were interviewed concerning their menstrual characteristics and uterine cavity size was measured by 2-D ultrasonography. After insertion the women kept daily records of bleeding and pain for two reference periods of 90 days during the first year (Months 1-3 and 10-12). The correlation between uterine cavity measurements and numbers of days of bleeding/spotting and pain during the reference periods was analysed. Continuation rates were assessed and reasons for discontinuation as well as the effects of baseline participant characteristics on outcomes were analysed in regression models. Both uterine cavity size and baseline menstrual characteristics prior to IUD insertion predicted the numbers of days of bleeding/spotting and pain in LNG-IUS users. Women with small uterine cavity dimensions reported less bleeding/spotting in both reference periods and less pain in the second reference period compared with women with larger dimensions. Baseline scanty spontaneous menstrual bleeding prior to LNG-IUS use (OR 9.4, 95% CI 1.7-51.8, P = 0.01) and smoking (OR 7.8, 95% CI 1.8-33.8, P = 0.006) predicted amenorrhoea in the second reference period. Women with baseline dysmenorrhoea reported more pain with both IUDs. Continuation rates and reasons for discontinuation were similar with both IUDs. No sample size could be calculated to estimate the power as this was a pilot study. As the majority of women chose the LNG-IUS we did not achieve our initial aim of equally sized IUD groups and thus the size of the copper IUD group may have been insufficient to detect differences. These data further encourage promotion of intrauterine contraception among nulligravid women. Routine use of ultrasonography to assess uterine cavity dimensions prior to IUD insertion is not indicated. Supported by Helsinki University Central Hospital research funds, the Swedish Cultural Foundation in Finland and Finska Läkaresällskapet, who provided funds for J.K. O.H. serves on advisory boards for Bayer Healthcare, Gedeon Richter and MSD Finland (part of Merck & Co. Inc.) and has designed educational events with these companies. S.S. has lectured in educational events at Bayer and MSD Finland (part of Merck & Co. Inc.) and is a member of the Advisory Board for Contraception at MSD Finland. The other authors have no conflicts of interest to declare. www.clinicaltrials.gov, NCT01685164.

Trends in family planning and counselling for women with sickle cell disease in the UK over two decades

BackgroundPregnancies in women with sickle cell disease (SCD) are known to have high rates of maternal and fetal mortality and morbidity. Given these pregnancy-associated problems for women with SCD, advice...

Levonorgestrel Intrauterine System in Adjuvant Tamoxifen Treatment: Balance of Breast Risks and Endometrial Benefits—Systematic Review of Literature

Levonorgestrel intrauterine system (LNG-IUS) is used in patients with breast patients taking tamoxifen (TAM) to prevent endometrial proliferation. The benefits (on endometrium), the side effects (on breast), and the patients suitable for this treatment are not still clear. Aim of this systematic review is to define the breast risks and endometrial benefits in TAM-treated women using Mirena and to define which patients could benefit from LNG-IUS use. In all, 3 studies on LNG-IUS effects on endometrium in TAM-treated women and 4 studies on breast cancer recurrence were selected for the study. All studies described a reduction in benign endometrial pathologies among Mirena users, but controversial data showed malignant disease and breast cancer recurrence. So it is mandatory to define hormonal status before TAM treatment. In selected patients Mirena was proven to protect endometrium. Perspective clinical trials on Mirena pharmacological features are necessary to establish whether systemic levels of progesterone could increase breast cancer recurrence in such patients.

Different bleeding patterns with the use of levonorgestrel intrauterine system: are they associated with changes in uterine artery blood flow?

Objective. Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS) are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis. Methodology. A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated. Results. A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I), amenorrheic women (Group II), and women with prolonged bleedings (Group III). Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI) and resistance index (RI) in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing—within subjects of Group III—mean PI and RI mean values before and after insertion. Conclusions. The LNG-IUS not only altered endometrial thickness, but—in women with prolonged bleedings—also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.

Complication Rates Associated with Levonorgestrel Intrauterine System Use in Adolescents with Developmental Disabilities

Study ObjectiveTo assess the complication rates with the use of the levonorgestrel intrauterine system (LNG IUS) in adolescents with developmental disabilities. DesignRetrospective chart review of all adolescents with developmental disabilities taken to the operating room for LNG IUS insertion between January 2000 and July 2009 at the Royal Children's Hospital, Melbourne, Australia. Cases identified from the surgical database, and medical records reviewed. Main Outcome MeasuresComplication rates with LNG IUS use in adolescents with development disabilities: non-insertion, uterine perforation, infection, and expulsion. ResultsFifty-six adolescents with developmental disabilities had an attempted LNG IUS insertion. The average age at insertion was 15.6 years (range 10.5-21.5 y). The LNG IUS was used as first line therapy in 14 cases (25%). Pre-insertion ultrasonography was ordered in 48% of cases, out of which 5 cases had uterine lengths <6 cm. Despite this, 4 of these cases had successful insertions. Two insertion attempts were abandoned intra-operatively (3.6%); one due to inadequate uterine length of 4 cm, and the other due to anatomic distortion. One spontaneous expulsion occurred at approximately 5 months (1.9%). Four IUDs were removed prematurely (7.4% withdrawal rate); 1 for persistent abdominal pain, 1 for irregular bleeding, and 2 for suspected malpositions. There were no documented cases of infection, perforation, or pregnancy. ConclusionOur experience in this population has been very positive and confirms that complication rates are comparable to that in adults.

Clinical Outcomes of Thermal Balloon Endometrial Ablation (Thermablate EAS) with and without Concomitant Use of Levonorgestrel Intra-Uterine System (LNG-IUS) in Women with Abnormal Uterine Bleeding: A Pilot Study

The LNG-IUS is an effective treatment of heavy menstrual bleeding (HMB) in up to 70% of women. The Thermablate balloon endometrial ablation (TBEA) system is comparable to all other nonhysteroscopic devices in treating HMB in up to 70% of women. In the present study, we hypothesized that combining the TBEA and LNG-IUS will increase clinical outcomes in over 70% of women.

Use of Levonorgestrel Intrauterine System for Medical Indications in Adolescents

The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis, and menstruation suppression in teens with physical or developmental disabilities. The LNG-IUS can also provide endometrial protection in teens with chronic anovulation, and may be used to treat endometrial hyperplasia and cancer. This review examines the evidence supporting the use of the LNG-IUS in adolescents for these noncontraceptive benefits.

Comparison of post-operative use of levonorgestrel-intrauterine system and cyclic oral contraceptive for prevention of endometrioma recurrence

The objective of this study is to compare the efficacy of postoperative use of levonorgestrel-releasing intrauterine system (LNG-IUS) and oral contraceptive for prevention of endometrioma recurrence. Retrospective study. Retrospective review of medical records of 141 reproductive-aged patients who had undergone laparoscopic surgery for endometrioma from January 2009 to December 2011 was performed. Patients were divided into two groups: a group that had postoperative LNG-IUS inserted (N=42) and a group that received postoperative cyclic, low-dose, monophasic oral contraceptives(OC) (N=99). Endometrioma recurrence was evaluated by an ultrasound. Mean age of LNG-IUS group and OC group was 40.26±4.40 and 32.97±5.56 and the difference was statistically significant (P<0.001). During the follow-up period (median, 17 months), recurrent endometriomas were detected in 13 patients (9.2%). Patients with LNG-IUS had recurrence rate of 4.8%(2/42), where patients receiving OC had recurrence rate of 11.1%(11/99). Cumulative recurrence-free survival revealed mean disease-free survival for LNG-IUS group and OC group were 34.44±1.01 months (95% CI: 33.11-35.90) and 33.41±0.98 months (95% CI: 31.42-35.35), respectively (P=0.015). Univariate analysis revealed hazard ratio (HR) of 0.168 (95% CI: 0.034-0.821) (P=0.028) for postoperative LNG-IUS use and endometrioma recurrence. However, on multivariate regression analysis, only postoperative serum CA-125 levels were significantly associated with endometrioma recurrence (HR:1.009, P=0.011). We demonstrated that post-operative use of LNG-IUS can be as effective as cyclic OC in prevention of endometrioma recurrence.

Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device

Background The levonorgestrel intrauterine system (LNG-IUS) combines a uterine foreign body and the continuous release of low-dose levonorgestrel for contraception. Its influence on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women, especially those who develop recurrent vaginosis or Candida vulvovaginitis. Study Design Slides of 286 women who had a Pap smear taken before and 1 to 2 years after placement of a LNG-IUS were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV). Results Prior to insertion, there were no differences in vaginal flora abnormalities between women using different kinds of contraception. LNG-IUS users did not have different rates of AVF, BV, AV or CV, but the general risk to develop any infection was increased. Uterine bleeding after insertion did not seem to predict a different flora type. Conclusion We found that Pap smears suggested more vaginal infections after 1 year of LNG-IUS use than prior to insertion of the device.

The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis

The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis

The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis

Background The objective of this study was to evaluate the efficacy and side effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of moderate or severe dysmenorrhea associated with adenomyosis for a 3-year follow-up period. Study Design The LNG-IUS was inserted into 94 women who had moderate or severe dysmenorrhea associated with adenomyosis diagnosed by transvaginal sonography during Cycle Days 5–7. A visual analogue scale (VAS) of dysmenorrhea, uterine volume and serum CA125 levels were used to assess the efficacy of the treatment at baseline and 3, 6, 12, 24 and 36 months after the LNG-IUS insertion. Side effects were recorded at every follow-up visit. Results The VAS of dysmenorrhea dropped continuously and significantly from the baseline score of 77.9±14.7 to 11.8±17.9 after 36 months of the LNG-IUS insertion (p<.001). The uterine volume decreased significantly from 113.8±46.9 mL to 94.5±40.1 mL (p=.003) at 6 months and to 87.7±35.8 mL (p<.001) at 12 months and then rose slightly, but the variables at 24 and 36 months still decreased significantly in comparison with the baseline variable (p<.001). The serum CA125 levels reduced significantly starting from 6 months after device insertion (p<.001). The most common side effects were weight gain (28.7%), simple ovarian cyst formation (22.3%) and lower abdominal pain (12.8%). At 36 months, the overall satisfaction rate of the treatment was 72.5%. Conclusions The LNG-IUS appears to be an effective method in alleviating dysmenorrhea associated with adenomyosis during 3 years. It may be a valuable long-term alternative for the treatment of adenomyosis.