Failed treatment of large adenomyosis with penetrating glandular distribution using hysteroscopic LNG-IUD suture fixation: a case report and literature review

Introduction Hysteroscopic LNG-IUD suture fixation is an innovative procedure for treating adenomyosis, effectively addressing the issue of expulsion. However, this case report presents a failed outcome and offers an exploratory summary of the indications for LNG-IUD. Materials and methods This case report describes a 38-year-old woman experienced a relapse of adenomyosis 1 year after undergoing a hysteroscopic Mirena suturing procedure. A comparison of MRI images taken before and 1 year after the placement of the Mirena revealed a diffuse distribution of endometrial tissue on the posterior uterine wall. Despite the Mirena’s placement, the uterus continued to enlarge progressively. The adenomyosis lesion was excised laparoscopically, and the Mirena device was reinserted. Results The postoperative course was uneventful. At a follow-up 1 year later, the patient reported no dysmenorrhea and only occasional, intermittent vaginal bleeding. This case report highlights the limitation of LNG-IUS in treating advanced adenomyosis, even with suture fixation. Conclusion Hysteroscopic LNG-IUD suture fixation is not recommended as a long-term treatment option for patients with extensive adenomyosis characterized by glandular penetrating distribution. Although this procedure can prevent device detachment and temporarily alleviate symptoms, it does not offer a durable solution for such severe cases.