Improving the Quality of Life of AUB: A South Indian Experience Comparing Hysterectomy With LNG-IUS

Abstract Background: Abnormal uterine bleeding (AUB) is a common cause of morbidity in premenopausal women, typically managed by hysterectomy or the levonorgestrel-releasing intrauterine system (LNG-IUS). While hysterectomy offers definitive symptom control, LNG-IUS is increasingly promoted as a uterus-preserving alternative, in line with India’s national health policies under schemes Janani Shishu Suraksha Karyakram (JSSK) and Ayushman Bharat. This study evaluated the effectiveness and impact on quality of life (QoL) of the LNG-IUS compared to total laparoscopic hysterectomy (TLH), while also exploring clinical factors influencing LNG-IUS outcomes, including the potential impact of a cesarean scar niche. Methods: This prospective, comparative cohort study was conducted between March 2024 and May 2025 at a tertiary academic centre. Following their classification using the FIGO PALM-COEIN method, 80 women with AUB were enrolled and assigned to either the TLH group (n = 40) or the LNG-IUS group (n = 40). A rigorous clinical protocol ensured careful patient selection, exclusion of uterine anomalies or distorted cavities, and personalized counselling. Using standardized instruments like Pictorial Blood Loss Assessment Chart (PBAC), SF-36 for QoL, FSFI-6 for sexual function, and Visual Analog Scale (VAS) for dysmenorrhea, results were assessed at baseline and six months later. Results: The LNG-IUS group showed a significant reduction in menstrual blood loss, with mean PBAC scores declining from 243.75 ± 53.8 to 99 ± 10.75 (p < 0.001), accompanied by an improvement in hemoglobin levels. Among 17 women with large, symptomatic adenomyosis (excluding fibroids/polyps), the LNG-IUS achieved a 94% success rate with only one spontaneous expulsion, higher than in similar studies, with a continuation rate of 82.5% likely due to structured counselling and pre-insertion protocols. LNG-IUS users showed significant improvement in 7 out of 8 domains and in FSFI scores (8.44 to 9.08; p = 0.002), with notable gains in pain and sexual well-being. No cases of Mirena migration were recorded, likely due to gynecologist-performed real-time ultrasound and a structured follow-up with immediate post-insertion scan and imaging again after 1 month. Conclusion: The LNG-IUS is a safe, effective, and policy-compliant alternative to hysterectomy for AUB, providing significant improvements in bleeding control, QoL, and sexual function with the added benefit of uterine preservation. Trial Registration CTRI/2024/02/062537, Date of Registration 12/02/2024