{"paper_id":"3c321ca9-d9cf-4361-90a2-245eca01cf68","body_text":"Abstract\nEndometriosis, adenomyosis, and fibromatosis are benign uterine conditions affecting women at various ages with different symptoms. Medical treatment plays an important role in the management, especially in diffuse forms and in those women requiring preservation or restoration of fertility. Medical treatments are effective in improving symptoms: pain, abnormal uterine bleeding, and infertility, resulting very frequently in a more acceptable option than surgical treatment. The rationale for using medical treatment is based on the pathogenetic mechanisms of the diseases: sex steroid hormones aberrations, impaired apoptosis, and increased inflammation. Hormonal treatments (progestins, oral contraceptives, gonadotropin-releasing hormone analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding. An antiproliferative and anti-inflammatory effect of progestins, such as dienogest, danazol, and norethindrone acetate, suggests their use in medical management 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. In conclusion, based on new findings on pathogenetic mechanisms, new drugs are under development for the treatment of endometriosis, adenomyosis, and fibromatosis such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelets therapy.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nBurney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511–9.\nBulun SE. Endometriosis. N Engl J Med. 2009;360:268–79.\nTaylor HS, Giudice LC, Lessey BA, et al. Treatment of endometriosis-associated pain with Elagolix, an Oral GnRH antagonist. N Engl J Med. 2017;377:28–40.\nEdelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;2014(7):CD004695.\nBrown J, Farquhar C. Endometriosis: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2014;2014(3):CD009590.\nHarada T, Momoeda M, Taketani Y, et al. Dienogest is as effective as intranasal buserelin acetate for the relief of pain symptoms associated with endometriosis–a randomized, double-blind, multicenter, controlled trial. Fertil Steril. 2009;91:675–81.\nPetraglia F, Hornung D, Seitz C, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285:167–73.\nStrowitzki T, Faustmann T, Gerlinger C, Schumacher U, Ahlers C, Seitz C. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Women's Health. 2015;7:393–401.\nLee JH, Song JY, Yi KW, et al. Effectiveness of Dienogest for treatment of recurrent endometriosis: multicenter data. Reprod Sci. 2018;25:1515–22.\nLethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;4:CD002126.\nTaran FA, Wallwiener M, Kabashi D, et al. Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet. 2012;285:1571–6.\nBenagiano G, Habiba M, Brosens I. The pathophysiology of uterine adenomyosis: an update. Fertil Steril. 2012;98:572–9.\nZhai J, Vannuccini S, Petraglia F, Giudice LC. Adenomyosis: mechanisms and pathogenesis. Semin Reprod Med. 2020;38:129–43.\nAntero MF, Ayhan A, Segars J, Shih IM. Pathology and pathogenesis of Adenomyosis. Semin Reprod Med. 2020;38:108–18.\nVannuccini S, Tosti C, Carmona F, et al. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35:592–601.\nKoninckx PR, Ussia A, Zupi E, Gomel V. Association of Endometriosis and Adenomyosis: vast literature but scant conclusive data. J Minim Invasive Gynecol. 2018;25:745–8.\nDababou S, Garzon S, Laganà AS, et al. Linzagolix: a new GnRH-antagonist under investigation for the treatment of endometriosis and uterine myomas. Expert Opin Investig Drugs. 2021;30:903–11.\nFeghali E, Etrusco A, Haydamous J, et al. Concurrent diagnosis of Adenomyosis and congenital uterine anomalies: a review. J Pers Med. 2023;13:716.\nEtrusco A, Barra F, Chiantera V, et al. Current medical therapy for Adenomyosis: from bench to bedside. Drugs. 2023;83:1595–611.\nStreuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother. 2014;15:2347–60.\nFedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68:426–9.\nvan der Walt LA, Sanfilippo JS, Siegel JE, Wittliff JL. Estrogen and progestin receptors in human uterus: reference ranges of clinical conditions. Clin Physiol Biochem. 1986;4:217–28.\nAzziz R. Adenomyosis in pregnancy. A review. J Reprod Med. 1986;31:224–7.\nJi F, Yang XH, Ai Xing Zi AL, Ha Ni Ke Zi TX, He Y, Ding Y. Role of levonorgestrel-releasing intrauterine system in dysmenorrhea due to adenomyosis and the influence on ovarian function. Clin Exp Obstet Gynecol. 2014;41:677–80.\nNiu X, Luo Q, Wang C, Zhu L, Huang L. Effects of Etonogestrel implants on pelvic pain and menstrual flow in women suffering from adenomyosis or endometriosis: results from a prospective, observational study. Medicine (Baltimore). 2021;100:e24597.\nMuneyyirci-Delale O, Chandrareddy A, Mankame S, Osei-Tutu N, Gizycki H. Norethindrone acetate in the medical management of adenomyosis. Pharmaceuticals (Basel). 2012;5:1120–7.\nOsuga Y, Fujimoto-Okabe H, Hagino A. Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis: a randomized, double-blind, multicenter, placebo-controlled study. Fertil Steril. 2017;108:673–8.\nSchindler AE. Non-contraceptive use of hormonal contraceptives. Gynecol Endocrinol. 2008;24:235–6.\nPontis A, D'Alterio MN, Pirarba S, de Angelis C, Tinelli R, Angioni S. Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol. 2016;32:696–700.\nLumsden MA, Hamoodi I, Gupta J, Hickey M. Fibroids: diagnosis and management. BMJ. 2015;351:h4887.\nDonnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22:665–86.\nRackow BW, Arici A. Options for medical treatment of myomas. Obstet Gynecol Clin N Am. 2006;33:97–113.\nFriedman AJ, Lobel SM, Rein MS, Barbieri RL. Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1990;163:1114–9.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nEthics declarations\nCompeting Interests\nThe author(s) has no competing interests to declare that are relevant to the content of this manuscript.\nEthics Approval\nThe author(s) declares that this manuscript does not include primary research with human participants.\nThe author(s) declares that this manuscript does not include primary studies involving animals.\nRights and permissions\nCopyright information\n© 2026 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nSilvestri, C. et al. (2026). Hormonal Treatment for Endometriosis, Adenomyosis, and Fibromatosis. In: Genazzani, A.R., et al. Ethical, Efficacy and Safety Issues in Contraception. Reproductive Medicine for Clinicians, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-032-07322-8_13\nDownload citation\nDOI: https://doi.org/10.1007/978-3-032-07322-8_13\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-032-07321-1\nOnline ISBN: 978-3-032-07322-8\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}