Improving the Quality of Life in AUB: A South Indian Experience Comparing Hysterectomy with Levonorgestrel-Releasing Intrauterine System

Background: Abnormal uterine bleeding (AUB) is a common reason for gynaecological consultation and hysterectomy. Although the levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective conservative treatment, hysterectomy continues to be offered early in routine practice in India. While LNG-IUS has shown benefit in bleeding control and quality of life, most studies have evaluated it independently. Comparative real-world evidence using standardised quality-of-life tools in women with structural AUB remains limited. This study compared clinical outcomes and patient-reported quality of life following LNG-IUS versus laparoscopic hysterectomy. Materials and Methods: A prospective observational comparative study was conducted between March 2024 and May 2025 at a tertiary care hospital. Eighty premenopausal women with AUB were allocated to LNG-IUS or laparoscopic hysterectomy based on shared decision-making and clinical suitability. Outcomes were assessed at baseline and six months using the Pictorial Blood Loss Assessment Chart (PBAC), haemoglobin levels, and SF-36 questionnaire (measuring health-related Quality of life). Results: Both groups showed significant improvement in clinical outcomes and quality of life (QOL). LNG-IUS reduced menstrual blood loss, approximately 59%, with 17.5% achieving amenorrhoea and 20% returning to normal cycles. Seven of eight SF-36 domains improved after LNG-IUS, while hysterectomy improved six domains, with no significant change in pain or physical functioning. LNG-IUS demonstrated high continuation (82.5%) and satisfaction (77.5%) rates, and side effects such as spotting and functional ovarian cysts did not affect acceptability due to anticipatory counselling. Conclusion: LNG-IUS serves as an effective alternative to hysterectomy for AUB, improving symptoms and quality of life while avoiding surgical risks. Shared decision-making and standardised follow-up may reduce unnecessary hysterectomies, as several women initially planned for surgery continued LNG-IUS after symptomatic improvement.