A Randomized Controlled Trial of Microwave Endometrial Ablation versus Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 121–132

DOI: 10.46882/2026/IJOG/000487

Original Research Article

Title: A Randomized Controlled Trial of Microwave Endometrial Ablation versus Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding

Names of Authors: Emeka J. Obi¹, Funmilayo R. Adeyemi², Zainab H. Dogara¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
² Maternal Health Division, Federal Ministry of Health, Abuja, Nigeria

Abstract:
Heavy Menstrual Bleeding (HMB) severely diminishes women's health status and productivity. This multi-center randomized controlled trial compared the 2-year therapeutic efficacy, patient satisfaction, and complication rates of Microwave Endometrial Ablation (MEA) against the Levonorgestrel-Releasing Intrauterine System (LNG-IUS) in women with idiopathic HMB. Two hundred premenopausal women aged 35 to 48 years who failed initial first-line medical therapies were randomized to undergo either MEA (n = 100) or LNG-IUS insertion (n = 100). The primary outcome was measured as changes in menstrual blood loss using the pictorial blood loss assessment chart (PBAC) score at 12 and 24 months. Both interventions yielded a dramatic reduction in PBAC scores from baseline (p < 0.001). At 24 months, amenorrhea rates were significantly higher in the MEA group compared to the LNG-IUS cohort (64.0% vs. 41.0%, p = 0.002). The total treatment satisfaction score was slightly higher in the surgical ablation group (91.0% vs. 82.0%, p = 0.041). Treatment failure leading to alternative surgical procedures or hysterectomy occurred in 4.0% of the MEA cohort and 11.0% of the LNG-IUS cohort (p = 0.048), mostly driven by displacement or persistent breakthrough spotting in the device arm. Mild procedural pain and transient cramping were the most common complaints for MEA and LNG-IUS, respectively. Microwave endometrial ablation provides a highly effective, definitive non-incisional treatment for idiopathic heavy menstrual bleeding, demonstrating higher long-term amenorrhea rates and superior treatment compliance compared to the levonorgestrel intrauterine system.

Keywords: Heavy Menstrual Bleeding; Endometrial Ablation; Microwave Ablation; Levonorgestrel Intrauterine System; Amenorrhea; Treatment Satisfaction.

Manuscript Timeline: Received: April 15, 2026; Revised: June 11, 2026; Accepted: July 05, 2026; Published: August 14, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. A Randomized Controlled Trial of Microwave Endometrial Ablation versus Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding. International Journal of Obstetrics and Gynecology. 2026; 14(8): 121–132.

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