Treatment of Adenomyosis with Subcutaneous Etonogestrel Implants: A Clinical Observational Study in 17 Patients

Abstract

BackgroundAdenomyosis is a cause of chronic pelvic pain in women of reproductive age. The aim of this study was to investigate the effects of subcutaneous etonogestrel implantation on adenomyosis.Material/MethodsA clinical observational study included 17 women with adenomyosis who were treated with subcutaneous etonogestrel implants and followed-up for 12 months. Imaging and clinical observations were undertaken in the 17 patients at baseline (time 0), and at 3 months, 6 months, and 12 months following subcutaneous etonogestrel implantation. The following imaging and clinical findings were compared between baseline (time 0) and 12-month follow-up: menstrual bleeding pattern, dysmenorrhea, visual analog scale (VAS) pain score, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin, follicle-stimulating hormone (FSH) levels, luteinizing hormone levels, serum estradiol levels, and any treatment side effects.ResultsAll 17 patients treated with etonogestrel implants completed the 12-month follow-up, at which time, the mean hemoglobin level (127.08±2.56 g/L) was significantly higher compared with that at baseline (94.54±5.47 g/L; P<0.01); uterine volume, serum CA125, and VAS score for dysmenorrhea at 12 months (118.03±12.83 cm3, 34.58±9.66 U/mL, and 1.45±0.35, respectively) were significantly lower when compared with baseline (198.53±39.47 cm3, 100.41±49.89 U/mL, and 7.62±0.74, respectively) (P<0.01, for all). However, changes in bleeding pattern and amenorrhoea occurred after treatment in some women.ConclusionsSubcutaneous etonogestrel was effective in reducing some symptoms and signs of adenomyosis, including dysmenorrhea, anemia, serum CA125, and uterine volume.

Effects of Etonogestrel implants on pelvic pain and menstrual flow in women suffering from adenomyosis or endometriosis

“…One previous study has suggested that Etonogestrel implants may reduce the uterine volumes of adenomyosis patients. [ 12 ] However, according to data gathered in this study, we did not find any significant change in uterine volumes after treatment.…”

“…[ 9 – 11 ] Nevertheless, fewer studies were found in patients affected by adenomyosis, and all these studies were limited in sample size and follow-up time. [ 12 ] So, it did not allow us to draw a firm conclusion about the topic.…”

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

“…Moreover, adenomyosis may be associated with recurrent abortion, premature delivery, and complications of late pregnancy such as placenta previa 3–8. Drug therapy includes gonadotropin-releasing hormone agonists (GnRHa), oral contraceptive pills (OCs), levonorgestrel-releasing intrauterine devices (LNG-IUS or Mirena), high-dose progestins, danazol, aromatase inhibitors, and selective estrogen/progesterone receptor modulators can relieve symptoms effectively,9–11 but these drugs are only temporary, and pregnancy is not possible during drug therapy. In addition, some patients are refractory to drug therapy.…”

FSRH Guideline (February 2021) Progestogen-only Implant

“…Mean visual analogue scores for dysmenorrhoea fell significantly in the ENG-IMP group, but not in the control group over the 12-month study period. In a small prospective cohort study57 of use of the ENG-IMP by 17 women with adenomyosis-associated dysmenorrhoea, all participants reported reduced dysmenorrhoea by 3 months after insertion; mean visual analogue pain score was statistically significantly lower at 3 months than at baseline, with the improvement maintained at 12 months. Almost a third of the participants were amenorrhoeic at 12 months and a quarter reported infrequent bleeding.…”