{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:08:58Z","timestamp":1790860138324,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study investigated the safety and efficacy of hysteroscopic sutureless fixation of the levonorgestrel-releasing intrauterine system (LNG-IUS) for treating heavy menstrual bleeding (HMB), providing a viable therapeutic option for patients at high risk of LNG-IUS expulsion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ninety patients were enrolled and equally divided into three groups: conventional implantation of LNG-IUS group (control group), hysteroscopic suture fixation of LNG-IUS group (suture fixation group) and hysteroscopic sutureless fixation of LNG-IUS group (sutureless fixation group). The rates of LNG-IUS expulsion and displacement, complication rates, pre- and postoperative menstrual flow, pain scores, and life satisfaction scores were recorded for each of the three groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The LNG-IUS expulsion rate in the sutureless fixation group was 3.3% and the displacement rate was 10%. There was no significant difference compared to the suture fixation group (3.3% LNG-IUS expulsion rate and 16.7% displacement rate in the suture fixation group,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). There was a significant difference compared to the control group (13.3% expulsion rate and 23.3% displacement rate in the control group,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). There was no significant difference in the rate of postoperative complications among the three groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). Postoperative menstrual flow was significantly reduced in all three groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), pain scores were significantly reduced (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), and quality of life scores were significantly improved (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings indicate that hysteroscopic sutureless fixation of the LNG-IUS is a safe, effective, and minimally invasive surgical procedure to prevent the LNG-IUS expulsion. This procedure leads to a significant reduction in menstrual flow, relieves the symptoms of dysmenorrhea, and improves patient quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1705266","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:39:27Z","timestamp":1764743967000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hysteroscopic sutureless fixation of the levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding"],"prefix":"10.3389","volume":"12","author":[{"given":"Linjiang","family":"Shen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.3109\/00365516409060511","article-title":"Determination of menstrual blood loss","volume":"16","author":"Hallberg","year":"1964","journal-title":"Scand J Clin Lab Invest"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/j.1471-0528.2001.00020.x","article-title":"The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review","volume":"108","author":"Stewart","year":"2001","journal-title":"BJOG"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.ijgo.2014.09.027","article-title":"Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey","volume":"128","author":"Fraser","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S118","DOI":"10.1016\/j.contraception.2007.01.008","article-title":"Treatment of menorrhagia with an LNG-IUS","volume":"75","author":"Pakarinen","year":"2007","journal-title":"Contraception"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/S1028-4559(10)60034-4","article-title":"Insertion of the Mirena intrauterine system for treatment of adenomyosis-associated menorrhagia: a novel method","volume":"49","author":"Peng","year":"2010","journal-title":"Taiwan J Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1186\/s12905-024-03390-8","article-title":"The suture fixation of the levonorgestrel-releasing intrauterine device with hysteroscope for the treatment of adenomyosis in patients at high risk of device expulsion-a prospective observational study","volume":"24","author":"Mao","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1186\/s12905-022-01932-6","article-title":"An innovative surgical approach: suture fixation of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Womens Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1111\/j.1471-0528.1990.tb16249.x","article-title":"Assessment of menstrual blood loss using a pictorial chart","volume":"97","author":"Higham","year":"1990","journal-title":"Br J Obstet Gynaecol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1093\/humupd\/dmu046","article-title":"Systematic review of endometriosis pain assessment: how to choose a scale","volume":"21","author":"Bourdel","year":"2015","journal-title":"Hum Reprod Update"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s11136-004-0612-6","article-title":"Variation in Chinese population health related quality of life: results from a EuroQol study in Beijing","volume":"14","author":"Wang","year":"2005","journal-title":"China Medizinhist J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/1477-7525-1-7","article-title":"Do English and Chinese EQ-5D versions demonstrate measurement equivalence? An exploratory study","volume":"1","author":"Luo","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1111\/1471-0528.12768","article-title":"Bleeding patterns during the menopausal transition in the multi-ethnic study of women's health across the nation (SWAN): a prospective cohort study","volume":"121","author":"Paramsothy","year":"2014","journal-title":"BJOG"},{"key":"ref13","volume-title":"Heavy menstrual bleeding: assessment and management","year":"2021"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1097\/01.AOG.0000431815.52679.bb","article-title":"Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction","volume":"122","year":"2013","journal-title":"Obstet Gynecol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"CD005072","DOI":"10.1002\/14651858.CD005072.pub3","article-title":"Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery","volume":"1","author":"Abou-Setta","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/0010-7824(94)90109-0","article-title":"Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial","volume":"49","author":"Andersson","year":"1994","journal-title":"Contraception"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1705266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:39:27Z","timestamp":1764743967000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1705266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":16,"alternative-id":["10.3389\/fmed.2025.1705266"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1705266","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]},"article-number":"1705266"}}