In the LOKI trial and subsequent evidence, which medical therapy for adenomyosis-associated dysmenorrhoea and heavy bleeding demonstrated the most sustained symptom relief with reduced uterine volume?

• A Levonorgestrel-releasing intrauterine system (LNG-IUS) ✓
• B Combined oral contraceptive pill
• C Danazol
• D GnRH agonist alone for 6 months

Explanation

The LNG-IUS (Mirena, 52 mg levonorgestrel) is the most effective long-term medical treatment for adenomyosis-associated heavy bleeding and dysmenorrhoea, achieving significant reduction in menstrual blood loss and sustained benefit. The LOKI trial demonstrated high continuation rates and satisfaction. Combined OCP provides partial relief but is less effective than LNG-IUS. GnRH agonist provides temporary relief but symptoms recur after cessation and long-term use is limited by bone loss. Danazol has poor tolerability.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.