{"paper_id":"c6790a68-bc57-481e-92c5-6380476d46f1","body_text":"Abstract\nPurpose\nMedical management of adenomyosis largely revolves around symptom management, with very few drugs having received regulatory approval for the disease. However, the level of evidence supporting the use of pharmacological interventions is low, making it difficult to establish their efficacy in the treatment of adenomyosis. Hence, the aim of our systematic review is to identify the strength of evidence currently available and evaluate the effectiveness of different medical interventions in the management of adenomyosis.\nMethods\nThe search was performed in MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov. Articles published between 1 January 2010 and 30 November 2020 were considered. Randomized controlled trials and observational studies that assessed the efficacy of medical interventions in patients with adenomyosis were included. The quality of the data was analyzed using RevMan 5.3 software.\nResults\nLNG-IUS (levonorgestrel intrauterine system), dienogest and gonadotropin-releasing hormone (GnRH) analogues were effective in reducing pain, uterine volume and menstrual bleeding. However, these data were largely obtained in the non-trial setting and were fraught with issues that included patient selection, short duration of therapy, small sample size, and limited long-term safety and effectiveness data.\nConclusions\nAlthough LNG-IUS, dienogest and GnRH analogues have better evidence for effectiveness in adenomyosis, the need of the hour is to thoroughly evaluate other novel molecules for adenomyosis using well-designed randomized controlled trials.\nSimilar content being viewed by others\nReferences\nVannuccini S, Petraglia F (2019) Recent advances in understanding and managing adenomyosis. 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All authors contributed to the writing and revision of the final manuscript. The final manuscript was read and approved by all authors.\nEthics declarations\nEthical approval\nNot applicable.\nConflict of interest\nAll the authors have declared that there is no conflict of interest.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nRathinam, K.K., Abraham, J.J., S, H.P. et al. Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review. Eur J Clin Pharmacol 78, 531–545 (2022). https://doi.org/10.1007/s00228-021-03256-0\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00228-021-03256-0","source_license":"CC0","license_restricted":false}