{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:29:07Z","timestamp":1786739347446,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare the treatment failure rates in patients with adenomyosis who underwent transcervical resection of the endometrium (TCRE) and levonorgestrel intrauterine device (LNG-IUD) insertion versus those with LNG-IUD insertion alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>One hundred and forty-six women with adenomyosis and heavy menstrual bleeding (HMB) or dysmenorrhea were enrolled in this randomized controlled clinical trial (CTRI\/2020\/09\/027592). One group had TCRE with LNG-IUD insertion and the other group had only LNG-IUD insertion. Baseline assessment included quality of life score (World Health Organisation quality of life-BREF [WHO QOL-BREF]), and menorrhagia multi-attribute scale (MMAS) score. The patients in both the treatment arms were followed up for 12 months. The scores were reassessed at 12 months along with LNG-IUD expulsion rates and treatment failure, which included any of the following: hysterectomy for adenomyosis, persistent HMB, or persistent dysmenorrhea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The primary outcome of treatment failure was significantly lower in the TCRE + LNG-IUD group (7.14% vs. 25%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01; Risk ratio 3.45, 95% Confidence interval (1.35\u20138.83). The quality-of-life (WHO QOL-BREF) and MMAS scores at 12 months were also significantly better in the TCRE + LNG-IUD arm. None of the women in the combined TCRE and LNG-IUD group had LNG-IUD expulsion at 12 months compared to the LNG-IUD expulsion rate of 8.8% in the LNG-IUD alone group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.013).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A combination of TCRE with LNG-IUD had a lower failure rate at 12 months in women with adenomyosis compared to LNG-IUD alone. This combination also resulted in better quality of life and lowered the chance of LNG-IUD expulsion at 12 months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/gmit.gmit-d-25-00021","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T07:00:10Z","timestamp":1779865210000},"page":"227-231","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Levonorgestrel Intrauterine Device versus Combined Transcervical Resection of the Endometrium in the Management of Adenomyosis: A Randomized Clinical Trial"],"prefix":"10.4103","volume":"15","author":[{"given":"Murali","family":"Subbaiah","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, JIPMER, Puducherry, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavana","family":"Suriya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, AIIMS, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevetha","family":"Selvarajan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, JIPMER, Puducherry, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"R1-20260720","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s00228-021-03256-0","article-title":"Evaluation of pharmacological interventions in the management of adenomyosis: A systematic review","volume":"78","author":"Rathinam","year":"2022","journal-title":"Eur J Clin Pharmacol"},{"key":"R2-20260720","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/aogs.13798","article-title":"The role of levonorgestrel intra-uterine system in the management of adenomyosis: A systematic review and meta-analysis of prospective studies","volume":"99","author":"Abbas","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"R3-20260720","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00404-024-07546-7","article-title":"Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: Evidence mapping","volume":"310","author":"Shi","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"R4-20260720","doi-asserted-by":"crossref","first-page":"2518396","DOI":"10.1155\/2017\/2518396","article-title":"The role of hysteroscopy in the diagnosis and treatment of adenomyosis","volume":"2017","author":"Di Spiezio Sardo","year":"2017","journal-title":"Biomed Res Int"},{"key":"R5-20260720","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/S1074-3804(05)60158-2","article-title":"Insertion of Mirena after endometrial resection in patients with adenomyosis","volume":"10","author":"Maia","year":"2003","journal-title":"J Am Assoc Gynecol Laparosc"},{"key":"R6-20260720","first-page":"285","article-title":"Comparison of combined transcervical resection of the endometrium and levonorgestrel-containing intrauterine system treatment versus levonorgestrel-containing intrauterine system treatment alone in women with adenomyosis: A prospective clinical trial","volume":"58","author":"Zheng","year":"2013","journal-title":"J Reprod Med"},{"key":"R7-20260720","first-page":"641","article-title":"Prospective study of the treatment of adenomyosis by combining hysteroscopic transcervical resection of endometrium with levonorgestrel-releasing intrauterine system","volume":"37","author":"Chen","year":"2017","journal-title":"J Shanghai Jiaot Univ (Med Sci)"},{"key":"R8-20260720","doi-asserted-by":"crossref","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":"R9-20260720","doi-asserted-by":"crossref","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":"R10-20260720","first-page":"551","article-title":"The WHOQOL Group","volume":"28","year":"1998","journal-title":"Psychol Med"},{"key":"R11-20260720","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1111\/j.1471-0528.2011.03057.x","article-title":"The measurement properties of the menorrhagia multi-attribute quality-of-life scale: A psychometric analysis","volume":"118","author":"Pattison","year":"2011","journal-title":"BJOG"},{"key":"R12-20260720","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ijgo.2014.02.017","article-title":"Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system","volume":"126","author":"Youm","year":"2014","journal-title":"Int J Gynaecol Obstet"},{"key":"R13-20260720","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ejogrb.2007.02.003","article-title":"Partial and complete expulsion of the Multiload 375 IUD and the levonorgestrel-releasing IUD after correct insertion","volume":"137","author":"Merki-Feld","year":"2008","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"R14-20260720","first-page":"CD000329","article-title":"Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding","volume":"2","author":"Bofill","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"R15-20260720","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4103\/GMIT.GMIT_88_20","article-title":"Comparison of bipolar ball endometrial ablation and transcervical resection of the endometrium in the treatment of heavy menstrual bleeding: A randomized clinical trial","volume":"10","author":"Subbaiah","year":"2021","journal-title":"Gynecol Minim Invasive Ther"},{"key":"R16-20260720","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/j.1600-0412.1997.tb07856.x","article-title":"Does endometrial resection help dysmenorrhea?","volume":"76","author":"Moln\u00e1r","year":"1997","journal-title":"Acta Obstet Gynecol Scand"},{"key":"R17-20260720","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/j.1447-0756.2010.01251.x","article-title":"Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and\/or dysmenorrhea","volume":"36","author":"Preutthipan","year":"2010","journal-title":"J Obstet Gynaecol Res"},{"key":"R18-20260720","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.bpobgyn.2018.01.016","article-title":"Minimally invasive treatment of adenomyosis","volume":"51","author":"Dueholm","year":"2018","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"R19-20260720","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/PGP.0000000000000147","article-title":"Pathology of endometrial ablation failures: A clinicopathologic study of 164 cases","volume":"34","author":"Simon","year":"2015","journal-title":"Int J Gynecol Pathol"},{"key":"R20-20260720","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s10397-014-0861-5","article-title":"Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis","volume":"11","author":"Gordts","year":"2014","journal-title":"Gynecol Surg"},{"key":"R21-20260720","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.3390\/diagnostics13132182","article-title":"Diagnosis and treatment of adenomyosis with office hysteroscopy-a narrative review of literature","volume":"13","author":"Gkrozou","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"R22-20260720","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/humrep\/deaa307","article-title":"Adenomyosis of the inner and outer myometrium are associated with different clinical profiles","volume":"36","author":"Bourdon","year":"2021","journal-title":"Hum Reprod"},{"key":"R23-20260720","first-page":"100029","article-title":"The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes","volume":"3","author":"Rasmussen","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol X"}],"container-title":["Gynecology and Minimally Invasive Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/gmit.GMIT-D-25-00021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:28:14Z","timestamp":1786735694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/gmit.GMIT-D-25-00021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/gmit.gmit-d-25-00021","relation":{},"ISSN":["2213-3070","2213-3089"],"issn-type":[{"value":"2213-3070","type":"print"},{"value":"2213-3089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"2025-02-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}