Current and Future Medical Treatment of Adenomyosis

Tosti, Claudia; Troìa, Libera; Vannuccini, Silvia; Lazzeri, Lucia; Luisi, Stefano

doi:10.5301/je.5000261

Cited by 11 publications

(13 citation statements)

References 103 publications

(128 reference statements)

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“…In fact in both treatments a significant difference in uterine volume after 3 months was observed, without a relevant change in adenomyotic area (41% vs. 49%) at study completion (71). AIs seems to have a promising future for adenomyosis in cases of resistance to other treatments even though additional studies are needed (6).…”

Section: Novel Drugs Under Investigation Aromatase Inhibitorsmentioning

confidence: 87%

“…The clinical presentation is often mixed, and thanks to the improvement in imaging diagnostic accuracy (2)(3)(4), adenomyosis may be detected also in a relatively high proportion of asymptomatic women (5). Depending on a woman's age, reproductive status, and clinical symptoms, adenomyosis may also require a life-long management plan, where medical, surgical, and infertility treatment may play a role, alone or in combination (6).…”

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confidence: 99%

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Role of medical therapy in the management of uterine adenomyosis

Vannuccini

Luisi

Tosti

et al. 2018

Fertility and Sterility

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187

171

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Adenomyosis is a benign uterine condition affecting women at various ages with different symptoms. The management of these patients is still controversial. Few clinical studies focusing on medical or surgical treatment for adenomyosis have been performed. No drug is currently labelled for adenomyosis and there are no specific guidelines to follow for the best management. Anyhow, medical treatments are effective in improving symptoms (pain, abnormal uterine bleeding and infertility). The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis: sex steroid hormones aberrations, impaired apoptosis, and increased inflammation. Several nonhormonal (i.e., nonsteroidal anti-inflammatory drugs) and hormonal treatments (i.e., progestins, oral contraceptives, gonadotropin-releasing hormone analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding in adenomyosis. Gonadotropin-releasing hormone analogues are indicated before fertility treatments to improve the chances of pregnancy in infertile women with adenomyosis. An antiproliferative and anti-inflammatory effect of progestins, such as dienogest, danazol and norethindrone acetate, suggests their use in medical management of adenomyosis mainly to control pain symptoms. On the other hand, the intrauterine device releasing levonorgestrel resulted is extremely effective in resolving abnormal uterine bleeding and reducing uterine volume in a long-term management plan. Based on new findings on pathogenetic mechanisms, new drugs are under development for the treatment of adenomyosis, such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelets therapy.

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Section: Novel Drugs Under Investigation Aromatase Inhibitorsmentioning

confidence: 87%

mentioning

confidence: 99%

Role of medical therapy in the management of uterine adenomyosis

Vannuccini

Luisi

Tosti

et al. 2018

Fertility and Sterility

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187

171

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“…Adenomyosis has a negative impact on women’s quality of life in a high percentage of cases because of AUB and pain requiring a lifelong management plan through medical or surgical treatment 79 . The choice depends on the woman’s age, reproductive status, and clinical symptoms.…”

Section: Management Of Adenomyosismentioning

confidence: 99%

Recent advances in understanding and managing adenomyosis

2019

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Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the uterine myometrium and it is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified – International Federation of Gynecology and Obstetrics) classification of causes of abnormal uterine bleeding (AUB). Although it has always been considered the classic condition of multiparous women over 40 years old who have pain and heavy menstrual bleeding, diagnosed at hysterectomy, the epidemiological scenario has completely changed. Adenomyosis is increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging point of view, and the diagnosis remains difficult and unclear. A uniform and shared reporting system needs to be implemented in order to improve our understanding on imaging features, their relationship with pathogenic theories, and their importance in terms of clinical symptoms and response to treatment. In fact, adenomyosis pathogenesis remains elusive and not a single theory can explain all of the different phenotypes of the disease. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. Treatment requires a lifelong management plan as the disease has a negative impact on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome and has a high risk of miscarriage and obstetric complications.

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“…Several treatments, including hormonal therapy (gonadotropin-releasing hormone agonists [GnRHas], combined oral contraceptives [COCs], and progestins [norethindrone acetate, medroxyprogesterone, dienogest, DNG]) and levonorgestrel-releasing intrauterine system (LNG-IUS), are used to improve the patient's quality of life by providing symptomatic relief for pain and bleeding [3]. Women with symptomatic adenomyosis require life-long treatment [9]. While prolonged use of hormonal medications reduce the risk of recurrence, it prevents conception.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Kobayashi

2023

Gynecol Obstet Invest

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Background Adenomyosis is an estrogen-dependent gynecologic condition that can cause pain symptoms, heavy menstrual bleeding, and infertility. Several treatments, including hormonal therapy can improve patients' quality of life through alleviating symptoms. Dienogest (DNG), a 19-norsteroid derivative oral progestin, is a promising treatment option for adenomyosis. Objectives This review aims to summarize the clinical outcomes (efficacy and adverse events) of DNG treatment for symptomatic adenomyosis compared with other hormonal treatments, discuss the mechanism underlying adverse events, and identify future challenges. Methods A literature search was performed across the PubMed and Google Scholar databases up to March 2022 to identify relevant literature. Outcome Out of 449 identified records, 37 articles met the inclusion and exclusion criteria. Five prospective and three retrospective studies showed that DNG and other hormonal agents had similar efficacy for pain relief; however, the most common adverse event of DNG was abnormal uterine bleeding. Specific demographic and clinicopathologic characteristics have been identified as associated with an increased risk of bleeding. Several factors, such as diffuse or type I adenomyosis, advanced reproductive age, severe dysmenorrhea, elevated serum CA125 levels, or low hemoglobin levels, may be implicated in bleeding risk; however, there is no accurate and reliable parameter. Future challenges with the widespread use of DNG include validation of candidate risk indicators and approaches to treat diffuse or type I adenomyosis. Conclusions and Outlook DNG represents an important therapeutic option to be included in the treatment algorithm for adenomyosis owing to sufficient pain relief, despite high rates of bleeding-related adverse events. Clinicians should consider an individual’s potential risk factors for bleeding until high-quality evidence is available.

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Current and Future Medical Treatment of Adenomyosis

Abstract: a consistent confounding bias. On this basis, the incidence of adenomyosis in the general population seems to be misrepresented as affecting mainly 35-to 50-years-old multiparous women with menorrhagia and dysmenorrhea and short menstrual cycles (≤24 days in length) (5, 6).

Cited by 11 publications

References 103 publications

Role of medical therapy in the management of uterine adenomyosis

Role of medical therapy in the management of uterine adenomyosis

Recent advances in understanding and managing adenomyosis

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

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