A 40-year-old woman with MRI-confirmed diffuse adenomyosis presents with heavy menstrual bleeding and dysmenorrhea. She wishes to preserve her uterus and prefers long-term medical management. Which is the most appropriate first-line treatment?
- A Combined oral contraceptive pills
- B Levonorgestrel-releasing intrauterine system (LNG-IUS) ✓
- C GnRH agonist for 6 months
- D Copper intrauterine device
Correct answer: B. Levonorgestrel-releasing intrauterine system (LNG-IUS)
Explanation
The LNG-IUS (52 mg levonorgestrel) is first-line for adenomyosis-related heavy menstrual bleeding. It induces decidualization and atrophy of ectopic endometrial tissue, reduces menstrual blood loss by up to 90 percent, and provides contraception. Combined OCPs are less effective for adenomyosis. GnRH agonists are limited to short-term use due to hypoestrogenic side effects. Copper IUD worsens bleeding and is contraindicated.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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