{"paper_id":"81dfada5-e15a-4402-8280-d464ecd5c9c8","body_text":"Abstract\nBackground\nThe levonorgestrel-releasing intrauterine system (LNG-IUS) is effective for adenomyosis, yet expulsion frequently limits its clinical application. This study aimed to compare clinical outcomes of three hysteroscopic LNG-IUS placement techniques for adenomyosis.\nMethods\nThis retrospective cohort recruited 131 adenomyosis patients (non-suture fixation n = 32, suture fixation n = 23, conventional placement n = 76) at Fujian Maternity and Child Health Hospital from October 2024 to October 2025. The primary outcome was LNG-IUS expulsion or displacement. Follow-up assessments were performed at baseline, 1 month and 6 months after placement for uterine volume, endometrial thickness, hemoglobin, carbohydrate antigen 125, dysmenorrhea and menstrual blood loss. Intraoperative parameters and postoperative adverse events were recorded. Between-group comparisons used ANOVA or Kruskal-Wallis tests; within-group changes used repeated-measures ANOVA or the Friedman test, with Bonferroni correction for multiple comparisons. Subgroup analysis was stratified by uterine cavity depth (cut-off 9.0 cm). Propensity-score matching (1:1:1), generalized estimating equations (GEE) and Cox regression were applied for data analyses.\nResults\nExpulsion or displacement rates at 1 and 6 months were 0% in both fixation groups versus 19.74% and 27.63% in the conventional group (P < 0.01). All groups achieved significant improvements in clinical parameters (P < 0.001). For patients with uterine cavity depth > 9.0 cm, fixation techniques yielded lower expulsion or displacement rates and superior 6-month clinical improvements versus conventional placement; comparable efficacy was observed among all groups for depth ≤ 9.0 cm. Operation time was shorter for non-suture fixation and conventional placement than suture fixation (P < 0.001), whereas intraoperative blood loss and adverse reactions were similar (P > 0.05). In the PSM-matched cohort (n = 23 per group), expulsion-displacement remained 0% in fixation groups vs. 69.56% conventional. GEE analysis in the matched cohort further revealed significant group × time interactions across the longitudinal clinical outcomes (P < 0.05). Cox regression identified uterine volume > 150 cm³ as the only independent risk factor (HR = 8.822, 95% CI 3. 172–24. 530, P < 0.001).\nConclusions\nAll three methods effectively improve clinical outcomes in adenomyosis patients. For patients with cavity depth > 9.0 cm, hysteroscopic fixation methods were associated with significantly lower observed expulsion rates compared with conventional placement. Non-suture fixation has practical merits of shorter operative time and lower technical requirements. Further prospective studies are required for external validation.\nSimilar content being viewed by others\nAcknowledgements\nWe are very grateful to all of the participants in the present research. We also thank the reviewers for their valuable advice.\nDisclosure statement\nThe authors have nothing to disclose.\nFunding\nThis work was sponsored by the Fujian provincial health technology project (Grant number: 2023QNA058), the Startup Fund for scientific research, Fujian Medical University (Grant number: 2024QH1203), and the Fujian Provincial Natural Science Foundation of China (Grant number: 2026J0011302).\nAuthor information\nAuthors and Affiliations\nCorresponding authors\nEthics declarations\nEthics approval and consent to participate\nThis was a retrospective cohort study using anonymized clinical data. The study was approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (No. 2026KY153-01, approved on 29 April 2026). Written informed consent was waived by the ethics committee due to the retrospective, observational, and anonymized design of the study. All procedures were performed in accordance with the Declaration of Helsinki.\nConsent for publication\nWritten informed consent was obtained from the patients for publication of their ultrasound images and clinical photographs. All images have been anonymized such that no individual can be identified.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.\nAbout this article\nCite this article\nGuo, S., Huang, Q., Zhao, Y. et al. Clinical outcomes of three hysteroscopic levonorgestrel-releasing intrauterine system placement methods in the management of adenomyosis: a retrospective cohort study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04962-6\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04962-6","source_license":"CC0","license_restricted":false}