Introduction: Abnormal uterine bleeding (AUB) adversely affects quality of life and frequently results in anemia and hysterec tomy. The levonorgestrel-releasing intrauterine system (LNG-IUS) offers a conservative, fertility-preserving alternative for the management of heavy menstrual bleeding (HMB). Methods: This prospective interventional study was conducted from April 2023 to April 2025 at J.N. Medical College, AMU, Aligarh, and included 66 women diagnosed with AUB. LNG-IUS was inserted in the post-menstrual phase. Participants were evaluated at 3 and 6 months. Primary outcome measures included Pictorial Blood Assessment Chart (PBAC) score and hemo globin levels Results: The mean age of participants was 40.52 ± 5.80 years, with a mean BMI of 28.21 ± 4.68 kg/m². Mean hemoglobin levels improved significantly from 8.96 ± 1.49 g/dL at baseline to 9.97 ± 0.97 g/dL at 6 months (P < 0.001). The mean PBAC score decreased from 288.71 ± 83.38 to 80.27 ± 38.89, representing a 72.11% reduction (P < 0.001). Spotting was the most frequently reported side effect (53.0%), expulsion occurred in 9.1% of cases, and no uterine perforations were observed. Device removal was required in 6.1% of participants. Overall, patient satisfaction was 84.8%. Conclusion: LNG-IUS is a safe, effective, fertility preserving, first-line non-surgical therapy for AUB, significantly reducing men strual blood loss, dysmenorrhea, and anemia, with high patient satisfaction rates.