OC08.04: Oral administration of norethisterone acetate in women with adenomyosis: effects on ultrasound features and clinical symptoms

To evaluate the effects of medical treatment with norethisterone acetate (NETA) on ultrasound signs of adenomyosis, pain symptoms and abnormal uterine bleeding (AUB). 40 women in fertile age with an ultrasound diagnosis of adenomyosis were enrolled. The ultrasonographic sings of adenomyosis were recorded by 2 and 3-dimensional transvaginal ultrasound. The severity was defined with an ultrasonographic score system which divides the disease in focal or diffuse adenomyosis of the external myometrium and of junctional zone (JZ) and adenomyoma. For each type of lesion a score number from 1 to 4 was assigned according to the myometrial involvement and JZ alterations. The total scores obtained were classified in: mild (1-7), moderate (8-13) and severe (14-20). The presence and the severity of pain symptoms and AUB were investigated. The follow-up evaluation was done 6 months after the beginning of therapy. A subgroup (n = 10) of women underwent an additional visit 3 months after the discontinuation of therapy. Patients were classified according to the ultrasonographic score system for adenomyosis. Before medical therapy, the distribution was: mild adenomyosis in 25% (n = 10), moderate in 40% (n = 16) and severe in 35% (n = 14) of women. After 6 months of administration of NETA 5 mg daily, a significant decrease of the severe ultrasonographic score was shown, when the entire group of women was considered. Concerning each ultrasound features of adenomyosis, the treatment significantly reduced uterine volume, size of focal adenomyosis foci and intramiometrial cysts, while linear striations remained unchanged. After 6-months of treatment, pain symptoms and AUB showed a significant improvement. 3 months after the discontinuation, ultrasonographic severity of disease and clinical symptoms showed a slight worsening without statistically significant differences. Medical treatment with NETA shows a significant change of ultrasonographic features of adenomyosis improving the severity of disease and clinical symptoms.