Hysteroscopic polypectomy with vs. without levonorgestrel-releasing intrauterine system in women with endometrial polyps and dysmenorrhea.

OBJECTIVES

To evaluate, among premenopausal women with endometrial polyps and documented dysmenorrhea, whether levonorgestrel-releasing intrauterine system (LNG-IUS) placement after hysteroscopic polypectomy (HP) was associated with better outcomes.

METHODS

This retrospective cohort study analyzed 276 premenopausal women with pathologically confirmed endometrial polyps who underwent HP between January 2022 and December 2024. Patients were classified into an HP-alone group (n=162) or an HP+LNG-IUS group (n=114).

RESULTS

At 12 months, the HP+LNG-IUS group had lower VAS scores than the HP group (aMD=-0.36; 95 % CI, -0.60 to -0.12; p=0.004). Clinically meaningful dysmenorrhea improvement occurred in 79.82 % in the HP+LNG-IUS group and 65.43 % in the HP group (aOR, 2.22; 95 % CI, 1.23-3.99; p=0.008). HP+LNG-IUS was also associated with a lower 12-month PBAC score and thinner endometrium. Exploratory analyses showed lower measured FSH, LH, estradiol, and progesterone levels. Polyp recurrence was observed in 2.63 % in the HP+LNG-IUS group and 9.26 % in the HP group.

CONCLUSIONS

In this study, LNG-IUS placement after HP was associated with modestly lower pain scores, lower menstrual blood loss, thinner endometrium, and lower observed 12-month polyp recurrence. Residual confounding, sparse recurrence events, ultrasound-based recurrence ascertainment, and retrospective adverse-event capture limit causal and safety inferences. Prospective controlled studies are required.