Hysteroscopic polypectomy with vs. without levonorgestrel-releasing intrauterine system in women with endometrial polyps and dysmenorrhea.

Objectives: To evaluate, among premenopausal women with endometrial polyps and documented dysmenorrhea, whether levonorgestrel-releasing intrauterine system (LNG-IUS) placement after hysteroscopic polypectomy (HP) was associated with better outcomes. Methods: This retrospective cohort study analyzed 276 premenopausal women with pathologically confirmed endometrial polyps who underwent HP between January 2022 and December 2024. Patients were classified into an HP-alone group (n=162) or an HP+LNG-IUS group (n=114). Results: At 12 months, the HP+LNG-IUS group had lower VAS scores than the HP group (aMD=-0.36; 95 % CI, -0.60 to -0.12; p=0.004). Clinically meaningful dysmenorrhea improvement occurred in 79.82 % in the HP+LNG-IUS group and 65.43 % in the HP group (aOR, 2.22; 95 % CI, 1.23-3.99; p=0.008). HP+LNG-IUS was also associated with a lower 12-month PBAC score and thinner endometrium. Exploratory analyses showed lower measured FSH, LH, estradiol, and progesterone levels. Polyp recurrence was observed in 2.63 % in the HP+LNG-IUS group and 9.26 % in the HP group. Conclusions: In this study, LNG-IUS placement after HP was associated with modestly lower pain scores, lower menstrual blood loss, thinner endometrium, and lower observed 12-month polyp recurrence. Residual confounding, sparse recurrence events, ultrasound-based recurrence ascertainment, and retrospective adverse-event capture limit causal and safety inferences. Prospective controlled studies are required.