Current Medical Therapy for Adenomyosis: From Bench to Bedside

Abstract

Adenomyosis, characterized by the growth of endometrial tissue within the uterine wall, poses significant challenges in treatment. The literature primarily focuses on managing abnormal uterine bleeding (AUB) and dysmenorrhea, the main symptoms of adenomyosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid provide limited support for mild symptoms or symptom re-exacerbation during hormone therapy. The levonorgestrel-releasing intrauterine system (LNG-IUS) is commonly employed in adenomyosis management, showing promise in symptom improvement and reducing uterine size, despite the lack of standardized guidelines. Dienogest (DNG) also exhibits potential benefits, but limited evidence hinders treatment recommendations. Danazol, while effective, is limited by androgenic side effects. Combined oral contraceptives (COCs) may be less effective than progestins but can be considered for contraception in young patients. Gonadotropin-releasing hormone (GnRH) agonists effectively manage symptoms but induce menopausal symptoms with prolonged use. GnRH antagonists are a recent option requiring further investigation. Aromatase inhibitors (AIs) show promise in alleviating AUB and pelvic pain, but their safety necessitates exploration and limited use within trials for refractory patients. This review highlights the complexity of diagnosing adenomyosis, its coexistence with endometriosis and uterine leiomyomas, and its impact on fertility and quality of life, complicating treatment decisions. It emphasizes the need for research on guidelines for medical management, fertility outcomes, long-term effects of therapies, and exploration of new investigational targets. Future research should optimize therapeutic strategies, expand our understanding of adenomyosis and its management, and establish evidence-based guidelines to improve patient outcomes and quality of life.

Association between physical activity and risk of premenstrual syndrome among female college students: a systematic review and meta-analysis

“…The role of inositol, insulin-sensitizing compounds of promising efficacy, in exercise physiology should not be overlooked, while its actions on the muscle and nervous system may further influence the premenstrual syndrome in the context of the effects of physical activity [ 36 ]. In some pathologic conditions, such as adenomyosis [ 37 ] or uterine fibroids [ 38 ] may exacerbate premenstrual syndrome in some women. The role of physical activity interventions in non-pharmacologic treatments with relevant prevalent populations deserves further exploration and may also be able to influence premenstrual syndrome by improving the reproductive health of women with the condition.…”

The Cellular Respiration of Endometrial Biopsies from Patients with Various Forms of Endometriosis

“…But in the case of adenomyosis, with repeated bleeding, radical surgical treatment is performed, i.e., a hysterectomy [22], the consequences of which can also reduce the quality of life of patients. An accepted therapeutic treatment strategy is the use of hormonal drugs, which is accompanied by a large number of restrictions [23] and is, in some cases, contraindicated, especially if the patient is planning a pregnancy. Therefore, the search for new strategies for the therapeutic treatment of endometriosis remains relevant.…”

Artificial Intelligence in the Management of Women with Endometriosis and Adenomyosis: Can Machines Ever Be Worse Than Humans?

“…Monophasic low-dose hormonal contraceptives and progestins are considered first-line options for the treatment of endometriosis, as they have the most favorable safety/efficacy/ tolerability/cost profile [28,69]. As to what regards adenomyosis, no guidelines have been approved at the present time, although levonorgestrel-releasing intrauterine devices (LNG-IUDs) appear to be an effective first-line treatment [70][71][72]. Oral progestins, dienogest, in particular, and combined oral contraceptives (COCs) have also been proven to be effective in these patients [73][74][75].…”