Efficacy and safety of combined GnRH-a, hysteroscopic surgery, and LNG-IUS for adenomyosis with suboptimal HIFU ablation: a retrospective study.

OBJECTIVE

To evaluate the safety and efficacy of sequential combination therapy comprising gonadotropin-releasing hormone agonist (GnRH-a), hysteroscopic surgery (residual lesion resection plus endometrial ablation), and levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in patients with adenomyosis who exhibited suboptimal response to high-intensity focused ultrasound (HIFU) ablation (non-perfused volume (NPV) ratio < 50%).

METHODS

This retrospective study enrolled 71 patients with adenomyosis who underwent HIFU ablation with an NPV ratio < 50% and subsequently received three doses of GnRH-a, followed by hysteroscopic surgery (residual lesion resection plus endometrial ablation) with concurrent LNG-IUS insertion (HIFU-GHL regimen). All patients completed a minimum follow-up of 24 months. Clinical efficacy was assessed using the visual analogue scale (VAS) for dysmenorrhea and the sensation quantity scale (SQS) for menstrual blood volume at baseline and at 6, 12, 18, and 24 months post-treatment.

RESULTS

The median follow-up duration was 39 months (IQR: 29-53 months). The median NPV ratio following HIFU ablation was 22.2% (IQR: 12.0%-36.2%). Compared with baseline, significant reductions in both VAS and SQS scores were observed at all post-treatment time points (all p < 0.05), with no significant differences among the four follow-up intervals (p > 0.05). Only two patients (2.8%) required re-intervention for recurrent dysmenorrhea.

CONCLUSIONS

The sequential regimen of GnRH-a, hysteroscopic surgery (lesion resection plus endometrial ablation), and LNG-IUS insertion is a safe and effective uterine-preserving salvage strategy for adenomyosis patients with suboptimal HIFU ablation (NPV ratio < 50%). Prospective randomized trials with extended follow-up are warranted to validate these findings.