Application of modified subtotal resection of adenomyosis combined with LNG-IUS and GnRH-a sequential therapy in severe adenomyosis: A case series

Qin, Zhenyue; Dong, Zhiyong; Tang, Heng; Zhang, Shoufeng; Bao, Mingyue; Wei, Weiwei; Shi, Ran; Chen, Jiming; Xia, Bairong

doi:10.3389/fsurg.2022.914725

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…Traditional Chinese medicine is not only beneficial to the treatment of clinical symptoms of adenomyosis, but also provides a completely individualized treatment concept more importantly (33). In fact, traditional Chinese medical treatment is highly individualized for all diseases, including adenomyosis.…”

Section: Traditional Chinese Medicinementioning

confidence: 99%

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Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

et al. 2023

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Adenomyosis is a diffuse or localized organic disease caused by benign invasion of endometrial glands and stroma into the myometrium. It is a common disease that seriously affects reproductive health of women in childbearing age. Due to the unknown etiology and pathophysiological mechanism, and the lack of unified diagnostic criteria and effective treatment methods, total or subtotal hysterectomy has become a radical treatment for adenomyosis, which will lead to the complete loss of fertility. With the continuous exploration of the treatment to adenomyotic patients who have infertility or fertility intentions, new drugs, surgical methods and treating concepts appears. Adopt individualized conservative therapeutic strategies for patients with different conditions, preserve the uterus as much as possible and protect the patient’s fertility, which will play an important role on the follow-up assisted reproductive treatment and long-term management of adenomyosis.

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Section: Traditional Chinese Medicinementioning

confidence: 99%

“…Gonadotropin releasing hormone agonist (GnRH-a) is an category of GnRH analog, whose affinity with GnRH receptor is much higher than that of natural GnRH ( 34 ). Long acting GnRH-a binds to a GnRH receptor in the pituitary gland to produce a transient increase in gonadotropin.…”

Section: Individualized Non-oral Drugs For Adenomyosismentioning

confidence: 99%

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

et al. 2023

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Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis

Chu,

Jia,

Dai

et al. 2024

J Ovarian Res

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Objective This trial was to investigate the effect of different treatment methods on the clinical efficacy and fertility outcome of patients with adenomyosis. Methods In total, 140 patients with adenomyosis were evenly and randomly allocated into group A (laparoscopic surgery), group B (laparoscopic surgery combined with gonadotropin-releasing hormone analogs [GnRH-a]), group C (ultrasound-guided percutaneous radiofrequency ablation), and group D (ultrasound-guided percutaneous radiofrequency ablation combined with GnRH-a). On the 3rd day after surgery, patients in group B and group D were subcutaneously injected with GnRH-a (Leuprorelin Acetate SR for Injection) at 3.75 mg/time, once every 4 weeks, for a total of 3 months. The therapeutic effects of the 4 groups were compared, including menstrual volume, dysmenorrhea score, uterine volume, clinical efficacy, luteinizing hormone (LH), estradiol (E2), and follicle-stimulating hormone (FSH) levels, CA125 levels, recurrence, pregnancy status, and pregnancy outcomes. Results After treatment, the menstrual volume of 4 groups was lowered, dysmenorrhea, Visual Analog Scale (VAS) score, LH, FSH, E2, and CA125 levels were reduced, and uterine volume was decreased. The menstrual volume, VAS score, levels of LH, FSH, E2, and CA125, and uterine volume were reduced in groups B, C, and D compared with group A, and the decrease was more significant in group D. The total effective rate of group D was 100.00%, which was higher than that of group A (71.43%), group B (80.00%), and group C (82.86%). After one year of drug withdrawal, the recurrence of hypermenorrhea, dysmenorrhea, uterine enlargement, and excessive CA125 in group D was significantly lower than that in groups A, B and C, and the recurrence in groups B and C was significantly lower than that in group A (P < 0.05). Compared with groups A, B, and C, group D had a higher pregnancy rate, natural pregnancy rate, and lower in vitro fertilization-embryo transfer rate (P < 0.05), but showed no significant difference in pregnancy outcomes. Conclusion Ultrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate is effective in the treatment of adenomyosis, which can effectively relieve clinical symptoms, protect postoperative ovarian function, reduce recurrence rate, alleviate pain, and improve quality of life.

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Clinical application of a simplified hysteroscopic LNG-IUD non-suture fixation in the treatment of adenomyosis

Yu,

Cong,

Sui

et al. 2024

Preprint

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Background Placement of a levonorgestrel-releasing intrauterine device (LNG-IUD) is an effective treatment forpatients diagnosed with adenomyosis who had a strong desire to preserve the uterus and had no immediate fertility requirements. However, there are also some limitations to the suitability of the LNG-IUD for women with adenomyosis, as adenomyosis causes distortion or enlargement of the uterine cavity. Therefore, the LNG-IUD is more prone to expulsion in patients with adenomyosis. In this study, we aimed to show an original and simplified approach using the hysteroscope for non-suture ﬁxation of LNG-IUD in patients with adenomyosis. Methods In this retrospectivecase series approved by the Ethics Committee of Obstetrics and Gynecology Hospital of Fudan University, sixty-two patients diagnosed with adenomyosis who had a strong desire to preserve the uterus and had no immediate fertility requirements in the short term were included in the study. They underwent hysteroscopic non-suture fixation of LNG-IUD. All patients underwent one-year postoperative follow-up to evaluate the LNG-IUD expulsion rate, postoperative efficacy and side effects. Results Sixty-two patients with adenomyosis underwent non-suture fixation with LNG-IUD and during the long-term postoperative follow-up, every patient experienced complete remission of their symptoms: a significant decrease in menstrual flow, relief of dysmenorrhea, and improvement in quality of life. Only two patients experienced expulsion of the LNG-IUD at 6 months and 10 months postoperatively, respectively. Conclusions Hysteroscopic non-suture fixation of the LNG-IUD can be a more simplified and minimally invasive alternative treatment for patients with a history of LNG-IUD expulsion. The non-suture method greatly reduces the complexity of hysteroscopic fixation and can be performed more efficiently in office.

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Application of modified subtotal resection of adenomyosis combined with LNG-IUS and GnRH-a sequential therapy in severe adenomyosis: A case series

Cited by 4 publications

References 43 publications

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

Individualized conservative therapeutic strategies for adenomyosis with the aim of preserving fertility

Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis

Clinical application of a simplified hysteroscopic LNG-IUD non-suture fixation in the treatment of adenomyosis

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