A 38-year-old woman with adenomyosis on MRI presents with menorrhagia and dysmenorrhoea, declining hysterectomy. The non-surgical treatment with the strongest evidence for reducing menstrual blood loss in adenomyosis is:
- A Levonorgestrel-releasing intrauterine system (LNG-IUS) ✓
- B Combined oral contraceptive pill
- C Tranexamic acid during menstruation
- D NSAIDs (naproxen) taken pre-emptively
Correct answer: A. Levonorgestrel-releasing intrauterine system (LNG-IUS)
Explanation
The LNG-IUS (Mirena) has the strongest evidence among non-surgical options for reducing menstrual blood loss in adenomyosis, with multiple studies showing significant reduction in menorrhagia and dysmenorrhoea, and it may reduce uterine volume over time. The effect is mediated by local progesterone-induced endometrial atrophy. Combined OCPs and GnRH agonists are also effective but GnRH-a is not suitable for long-term use. Tranexamic acid treats bleeding but does not address the underlying adenomyosis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.