{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:59:52Z","timestamp":1788998392181,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with adenomyosis frequently experience menorrhagia and dysmenorrhea. Levonorgestrel-releasing intrauterine device (LNG-IUD) and oral norethindrone are widely used non-surgical treatment options. However, their associated risks of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) have not been well reported in the previous studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multi-institutional retrospective analysis was performed using de-identified electronic health records from the TriNetX Research Network. Patients with adenomyosis treated with LNG-IUD or oral norethindrone were identified. A 1:1 propensity score matching (PSM) was conducted to control for potential confounding variables. Subgroup analysis was performed to evaluate the outcomes of the patient group with hemoglobin (Hb) \u226510 g\/dL or Hb &amp;lt;10 g\/dL. Primary outcomes include risks of PID and BV. Secondary outcomes included risks of severe anemia (Hb &amp;lt; 10 g\/dL), breast cancer, mood disorder, and cancer antigen 125 (CA-125) &amp;gt;35 U\/mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After PSM, the LNG-IUD group showed a significantly lower risk of PID (hazard ratio (HR) 0.545; 95% confidence interval (CI) 0.483\u20130.616) and Hb &amp;lt;10 g\/dL (HR 0.850; 95% CI 0.775\u20130.932) compared with the oral norethindrone group. In contrast, the risk of BV was significantly higher in the LNG-IUD group (HR 1.223; 95% CI 1.116\u20131.342). No significant differences were observed between the two groups regarding associated breast cancer, mood disorder, or CA-125 \u2265 35 U\/mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrated that in patients with adenomyosis, treatment with LNG-IUD, compared with oral norethindrone, was associated with a lower risk of PID and severe anemia (Hb &amp;lt; 10 g\/dL) but a higher risk of BV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1703310","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T05:16:49Z","timestamp":1764566209000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risks of pelvic inflammatory disease and bacterial vaginosis in adenomyosis patients using levonorgestrel intrauterine device or oral 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