Objective To investigate the clinical value of hysteroscopic transcervical resection of endometrium(TCRE) with levonorgestrel-releasing intrauterine system (Mirena) in treatment of adenomyosis. Methods Ninety-four patients with adenomyosis were randomly divided into combined treatment group (n=42), Mirena group (n=42) and TCRE group (n=21). Patients were followed up for 24 months after treatment, and the volumes of menstrual bleeding, hemoglobin levels, dysmenorrhea scores, volumes of uterus, serum CA125 levels, rates of recurrence and incidences of complications were observed. Results The volumes of menstrual bleeding were lower, the hemoglobin levels were higher, and the dysmenorrhea scores and serum CA125 levels were lower at each time point after treatment than those before treatment in three groups (P<0.05). The volumes of uterus 3 months, 6 months and 12 months after treatment were significantly smaller than those before treatment in three groups (P<0.05). Twelve and 24 months after treatment, the dysmenorrhea scores and volumes of uterus rebounded, and the volumes of uterus tended to increase in TCRE group, and the volumes of uterus in combined treatment group were significantly smaller than those in Mirena group

and TCRE group (P<0.05). The rate of recurrence 24 months after treatment and the incidences of irregular small amount of vaginal bleeding 3 to 6 months after treatment in combined treatment group were significantly lower than those in Mirena group and TCRE group (P<0.05). Conclusion TCRE with Mirena may be an effective approach in treatment of adenomyosis, with lower rate of recurrence and incidence of complications.