Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis

Sho Matsubara, Ryuji Kawaguchi, Mika Akinishi, Mika Nagayasu, Kana Iwai, Emiko Niiro, Yuki Yamada, Yasuhito Tanase, Hiroshi Kobayashi
Scientific reports · 2019 · vol. 9(1) , pp. 17654 · doi:10.1038/s41598-019-54096-z · PMID:31776404 · PMC6881344 · W2990162191
article OA: gold CC0 ⤵ 27 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Subtype I adenomyosis was identified as an independent risk factor for serious unpredictable bleeding in patients with symptomatic adenomyosis receiving dienogest therapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective cohort study analyzed medical records of 84 women with MRI-diagnosed symptomatic adenomyosis treated with continuous oral dienogest (2 mg daily) between 2008 and 2017 to identify risk factors for dienogest-related serious unpredictable bleeding, defined by hemoglobin drop and/or hemoglobin thresholds plus unpredictability criteria. After exclusions (missing MRI subtype I/II classification or missing hemoglobin data), 37 patients were analyzed and 14 experienced serious unpredictable bleeding; univariate comparisons showed significant differences in minimum hemoglobin during treatment and in shorter dienogest treatment duration. Subtype I (intrinsic) adenomyosis was significantly associated with serious unpredictable bleeding (p = 0.027), while age, parity, baseline hemoglobin, prior endometrial curettage, and multiple uterine/adenomyosis size metrics were not significantly different between groups. The paper does not extensively discuss limitations beyond the retrospective design and substantial exclusions (e.g., lack of subtype classification and missing hemoglobin), which could affect generalizability. This paper is centrally about adenomyosis — it identifies intrinsic (subtype I) adenomyosis as an independent risk factor for serious unpredictable bleeding during dienogest therapy.

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Abstract

We aimed to retrospectively analyze the risk factors of a continuous dienogest (DNG) therapy for serious unpredictable bleeding in patients with symptomatic adenomyosis. This is a retrospective study based on data extracted from medical records of 84 women treated with 2 mg of DNG orally each day between 2008 and 2017. 47 subjects were excluded from the original analyses due to an inadequate subcategorization into subtype I and subtype II and a lack of hemoglobin levels. The influence of various independent variables on serious unpredictable bleeding was assessed. Of the 37 eligible patients who received the continuous DNG therapy, 14 patients experienced serious unpredictable bleeding. Univariate analysis revealed that the serious bleeding group had subtype I adenomyosis (P = 0.027). There was no correlation between age, parity, minimum hemoglobin level before treatment, previous endometrial curettage, and duration of DNG administration, or uterine or adenomyosis size and the serious bleeding. A DNG-related serious unpredictable bleeding is associated with the structural type of adenomyosis (subtype I) in patients with symptomatic adenomyosis.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Hemorrhage Nandrolone Adenomyosis Adult Contraceptives, Oral, Hormonal Contraceptives, Oral, Hormonal Contraceptives, Oral, Hormonal Female Hemorrhage Humans Middle Aged Nandrolone Nandrolone Nandrolone Retrospective Studies Risk Factors

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