{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:27:34Z","timestamp":1774430854082,"version":"3.50.1"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"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>Introduction<\/jats:title>\n                    <jats:p>Hysteroscopic LNG-IUD suture fixation is an innovative procedure for treating adenomyosis, effectively addressing the issue of expulsion. However, this case report presents a failed outcome and offers an exploratory summary of the indications for LNG-IUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This case report describes a 38-year-old woman experienced a relapse of adenomyosis 1\u202fyear after undergoing a hysteroscopic Mirena suturing procedure. A comparison of MRI images taken before and 1\u202fyear after the placement of the Mirena revealed a diffuse distribution of endometrial tissue on the posterior uterine wall. Despite the Mirena\u2019s placement, the uterus continued to enlarge progressively. The adenomyosis lesion was excised laparoscopically, and the Mirena device was reinserted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The postoperative course was uneventful. At a follow-up 1\u202fyear later, the patient reported no dysmenorrhea and only occasional, intermittent vaginal bleeding. This case report highlights the limitation of LNG-IUS in treating advanced adenomyosis, even with suture fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hysteroscopic LNG-IUD suture fixation is not recommended as a long-term treatment option for patients with extensive adenomyosis characterized by glandular penetrating distribution. Although this procedure can prevent device detachment and temporarily alleviate symptoms, it does not offer a durable solution for such severe cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1762481","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:54:52Z","timestamp":1774421692000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Failed treatment of large adenomyosis with penetrating glandular distribution using hysteroscopic LNG-IUD suture fixation: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenhui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pathology, Hangzhou Women\u2019s Hospital (Hangzhou Maternity and Child Health Care Hospital)","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hangzhou Women\u2019s Hospital (Hangzhou Maternity and Child Health Care Hospital)","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gensheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Anqing Hospital Affiliated to Anhui Medical University","place":["Anqing, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hangzhou Women\u2019s Hospital (Hangzhou Maternity and Child Health Care Hospital)","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/j.fertnstert.2012.06.044","article-title":"The pathophysiology of uterine adenomyosis: an update","volume":"98","author":"Benagiano","year":"2012","journal-title":"Fertil Steril"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e20421","DOI":"10.1097\/MD.0000000000020421","article-title":"Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis","volume":"99","author":"Song","year":"2020","journal-title":"Medicine"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.tjog.2014.05.009","article-title":"Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic 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Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group","volume":"46","author":"Van den Bosch","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"102785","DOI":"10.1016\/j.ijgc.2025.102785","article-title":"Levonorgestrel-releasing intra-uterine device alone for managing early-stage endometrial cancer and endometrial hyperplasia with atypia in patients unfit for surgery: the ENDOIUD study","volume":"36","author":"Petrillo","year":"2026","journal-title":"Int J Gynecol Cancer"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1002\/ijgo.14650","article-title":"Heterogeneity of clinical symptoms and therapeutic strategies for different subtypes of adenomyosis: an initial single-center study in China","volume":"161","author":"Han","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2228","DOI":"10.1056\/nejmoa1700732","article-title":"Contemporary hormonal contraception and the risk of breast cancer","volume":"377","author":"M\u00f8rch","year":"2017","journal-title":"N Engl J Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1007\/s43032-022-01077-9","article-title":"Levonorgestrel-releasing intrauterine system improves menorrhagia-related quality of life in patients with symptomatic adenomyosis","volume":"30","author":"Ishizawa","year":"2023","journal-title":"Reprod Sci"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1093\/humrep\/14.4.970","article-title":"The effect of a levonorgestrel-releasing intrauterine device on human endometrial oestrogen and progesterone receptors after one year of 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