Hysteroscopic Suture Fixation of the Levonorgestrel-Releasing Intrauterine System Reduces Re-Expulsion and Improves Outcomes in Women With a History of Prior Expulsion

Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective contraceptive and non-surgical treatment for various gynecological conditions. However, its high expulsion rate remains a concern, particularly in women with a history of prior expulsion. This study aimed to evaluate the effectiveness of non-absorbable suture fixation under hysteroscopic guidance to reduce expulsion rates. Methods: A total of 73 women with a history of LNG-IUS expulsion were enrolled between August 2022 and August 2023 at the Women's Hospital, Zhejiang University School of Medicine. All participants underwent hysteroscopic suture fixation of the LNG-IUS. Postoperative assessments were conducted on days 1, 3, and 7 using electronic questionnaires, along with outpatient follow-up and ultrasonography at 1, 3, and 6 months. Results: All 73 procedures were successfully performed as outpatient (day) surgeries, with a mean duration 37.81 ± 14.90 min, without encountering any complications. Follow-up was conducted for all 73 patients at 6 months, with 70 patients undergoing postoperative imaging, primarily using ultrasonography. Low rates of expulsion (4.29%) and downward-shift (7.14%) were observed. Decreased menstrual bleeding or amenorrhea was reported by 68 patients (93.15%). Among the 47 patients with preoperative dysmenorrhea, complete symptom relief was achieved in 39 cases (82.97%). Conclusions: In patients with a history of LNG-IUS expulsion, hysteroscopic suture fixation of the LNG-IUS not only lowers the rate of re-expulsion but also alleviates associated symptoms.