A 42-year-old woman with adenomyosis confirmed on MRI (junctional zone 16 mm) has heavy menstrual bleeding and dysmenorrhea. She declines hysterectomy. Which medical therapy has the strongest evidence for efficacy in adenomyosis-related heavy menstrual bleeding?
- A Levonorgestrel-releasing intrauterine system (LNG-IUS) ✓
- B Combined oral contraceptive pills
- C Non-steroidal anti-inflammatory drugs alone
- D Tranexamic acid alone
Correct answer: A. Levonorgestrel-releasing intrauterine system (LNG-IUS)
Explanation
The levonorgestrel-releasing intrauterine system (52 mg LNG-IUS) has the strongest evidence for reducing heavy menstrual bleeding and pain in adenomyosis. It induces decidualization and atrophy of ectopic endometrial tissue through local progestogenic action. Combined OCPs, NSAIDs, and tranexamic acid provide symptomatic relief but are less effective than LNG-IUS for adenomyosis specifically. GnRH agonists are effective but limited by hypoestrogenic side effects with prolonged use.
Reference: Williams Gynecology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.