The Levonorgestrel IUD (Mirena) as an Alternative to Hysterectomy for Treatment of Adenomyosis

Diffuse adenomyosis as seen on transvaginal ultrasound

Adenomyosis is a benign condition in which the glands that normally line the inner cavity of the uterus grow within its muscular walls, causing uterine enlargement, heavy, painful menses and anemia. Adenomyosis can be likened to endometriosis within the uterus and, in fact, often co-exists with pelvic endometriosis.

Not all women with adenomyosis have symptoms, and those with mild symptoms can find relief with oral contraceptives or Depo Provera. But for women with more extensive disease whose quality of life and health are threatened by heavy bleeding and pain, and for whom these hormonal interventions fail, the best treatment until now has been hysterectomy.

Now a new study shows that the levonorgestrel IUD (Mirena) may be just as effective as hysterectomy in treating adenomyosis.

The data

Researchers in Turkey randomly assigned women with strictly-diagnosed adenomyosis to treatment with either hysterectomy or insertion of a levonorgestrel IUD (Mirena). At baseline, all the women had heavy menses for at least 6 months, in addition to other symptoms such as dysmenorrhea and painful intercourse. The mean hemoglobin in the groups was 10 gm/dL, indicating significant anemia.

At one year post treatment, both hysterectomy and IUD groups had normal hemoglobin levels and improved quality of life as measured by the World Health Organizations Quality of Life Questionnaire. The study authors state that the IUD group had a greater improvement in psychological and social measures, but I suspect this was because the IUD group has lower scores in these domains at baseline.

Complications of hysterectomy were limited to post op wound infection in one patient. IUD users experienced headache (11%) , acne (5%) , breast tenderness (7%) and transient mood issues (1 subject), but no woman requested removal of her IUD due to side effects. One woman expelled her IUD and went on to hysterectomy.

The Study Has Important Limitations

The authors do not tell us what treatments women had tried before entering this study, so I am a bit wary that they may not have adequately sampled the group of women with adenomyosis who are most likely to warrant hysterectomy – those women who have tried and failed hormonal treatments such as birth control pills. One would never proceed to hysterectomy without at least trying these interventions. If the group studied here included all comers with adenomyosis, and if Mirena was their first attempt at treating the condition, than of course the IUD would prove to be effective (and hysterectomy potentially unnecessary). In the same way, oral contraceptives could be said to be an effective hysterectomy alternative for adenomyosis.

Bottom Line

Not all adenomyosis needs to be treated. But if adenomyosis is causing significant symptoms, the Mirena IUD can be added to the list of treatment options, and may prevent the need for hysterectomy in women with the more severe forms of the condition. Although this particular study is only one year, previous research on Mirena use in adenomyosis has found that it remains effective for at least 3 years, although side effects reduce satisfaction a bit over time.

For any given women, if Mirena’s benefits don’t persist, or if its side effects become intolerable, hysterectomy is still there as an effective and definitive solution to the problem.

Of note, Mirena has also proven to be effective in treating endometriosis.


Image from Geneva Foundation for Medical Education and Research (I believe these images are royalty free…)

6 Responses to The Levonorgestrel IUD (Mirena) as an Alternative to Hysterectomy for Treatment of Adenomyosis

  1. Until it perforates like mine did, lol. I had it inserted after a lap to remove endo in May 2009. It perforated in Sept 09 and I finally made my way to the ER after a month of excruciating back pain. My symptoms presented the same as a kidney stone. Was that a surprise when they did a cat scan. Instead of a stone, they found my IUD in my left abdomen floating around. I eventually had the hysterectomy last November. Life is so much better.

  2. i’m scheduled for mirena coil, but i’m scared of my life now,.i don’t know why gyne’s still recommend this,.after reading all the reviews,i have never read anything positive about it..

  3. Do NOT do get the Mirena IUD! At least consider any other option. After only one year, I ended up having it surgically removed and then only 4 months later had to get a hysterectomy. What started out as “treatment ” for heavy bleeding has left me unable to have children.

  4. The Mirena lightened but not stopped my heavy bleeding. For 18 months I noticed bleeding constantly throughout the month, albeit very pale and barely noticeable. I started having cramps and the IUD had moved to the lower 3rd of the uterine area. It was discovered by ultrasound that I have adenomyosis. I did not have this condition prior to the IUD insertion. The Mirena releases progesterone to thin the lining of the womb and for heavy bleeders this is a godsend. For some though it is not the total 100% answer they are hoping for. I had it removed recently and now am bleeding 10 times worse than before. THAT is NOT the Mirena’s fault! That is my own biology. I had already started bleeding heavier each month so the IUD being in me was providing relief but not fixing the original problem. The Mirena is the 1st part of treatment for most women. It usually works. There is no 100% treatment for heavy bleeding except the hysterectomy. Sad but true. Good luck to all who read this and I hope peace and happiness is yours.

  5. SO confused with the insertion of of Mirena. Do Hysterectomy has side effects, if that is the last resort for ladies having adenomyosis.

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