To evaluate the clinical efficacy of thermal balloon endometrial ablation (TBA) combined with the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) in the treatment of perimenopausal dysfunctional uterine bleeding, so as to provide a better treatment for patients with abnormal uterine bleeding.

One hundred and two patients with abnormal uterine bleeding who were treated at Shougang Hospital of Peking University from July 2018 to October 2020 were selected and divided into three groups according to different treatment methods used: LNG-IUS group, TBA group, and combination therapy group. The LNG-IUS group (55 cases) was treated with LNG-IUS, the TBA group (21 cases) was treated with TBA, and the combination therapy group (26 cases) was treated with LNG-IUS and TBA. The patients were followed at 6 months and 1 year after the surgery. The clinical efficacy, the reduction of menstrual quantity assessed with pictorial blood loss assessment chart, endometrium thickness, and hemoglobin level after treatment were compared among the three groups.

The total effective rates at 6 months and 1 year after treatment were 70.90% and 76.36% in the LNG-IUS group, 71.43% and 80.95% in the TBA group, and 96.15% and 100% in the combination therapy group, respectively. There was no significant difference between the LNG-IUS and TBA groups at 6 months after treatment (P＞0.05), though there was significant difference between the two groups at 1 year (P＜0.05); the total effective rates at 6 months and 1 year in the combination therapy group were higher than those in the other two groups (P＜0.01). There was no significant difference in menstrual volume score, endometrial thickness, or hemoglobin level among the three groups before treatment (P＞0.05). The menstrual volume scores at 6 months and 1 year were significantly lower than those before treatment in all the three groups (P＜0.05), and they were lower in the combination therapy group than in the other two groups (P＜0.05). The endometrial thickness at 6 months and 1 year was significantly lower than that before treatment in all the three groups (P＜0.05), and the endometrial thickness at 6 months and 1 year was significantly lower in the combination therapy group than in the other two groups (P＜0.01). The hemoglobin levels at 6 months and 1 year were significantly higher than those before treatment in all the three groups (P＜0.05), and the hemoglobin levels at 6 months and 1 year were significantly higher than those of the other two groups (P＜0.01). At the 6-month follow-up, three cases of expulsion of IUD occurred in the LNG-IUS group, but no expulsion of IUD occurred in the combination therapy at both the 6-month and 1-year follow-up. After long-term follow-up, it was found that in the LNG-IUS group, hysterectomy was performed in two cases due to poor treatment effect and repeated bleeding, and another case was treated with TBA. In the TBA group, hysterectomy was performed in one case due to repeated bleeding. However, in combined therapy group, no hysterectomy or other treatment was performed due to poor results.

LNG-IUS, TBA, and their combination are all effective in the treatment of abnormal uterine bleeding. The combination of TBA and LNG-IUS has more advantages in reducing menstrual quantity and improving anemia, representing a better treatment choice for patients with abnormal uterine bleeding.