Medical treatment for adenomyosis: long term use of progestins

Silvia Vannuccini, Francesco La Torre, Filippo La Torre, Federico Toscano, Anna Rosa Speciale, Milo Giani, Dilruba Türeli, Dilruba Tureli, Virginia Manzi, Angela Gallone, Felice Petraglia
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2025 · vol. 41(1) , pp. 2511329 · doi:10.1080/09513590.2025.2511329 · PMID:40424290 · W4410769949
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

Dienogest, levonorgestrel IUDs, drospirenone, and desogestrel effectively manage adenomyosis symptoms long-term, though switching treatments is common due to side effects or declining efficacy.

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Abstract

BACKGROUND: Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are available on their long-term use in adenomyosis. OBJECTIVE: To evaluate the long-term efficacy of different progestins, including progestin-only pills (POP), for the management of adenomyosis-related symptoms. METHODS: = 24). Symptoms were assessed using the Visual Analogue Scale (VAS) for pain and the Pictorial Blood Assessment Chart (PBAC) method for bleeding. RESULTS: Dienogest significantly reduced dysmenorrhea, dyspareunia, and HMB, with efficacy maintained over three years in most patients. However, after the first year 49% of patients required a switch to other treatments due to side effects or contraception need. The levonorgestrel-releasing intrauterine device also effectively managed HMB and pain, with 15% of patients switching treatment due to side effects. Both drospirenone and desogestrel improved HMB and dysmenorrhea, but desogestrel had a higher discontinuation rate due to reduced long-term efficacy. Norethisterone acetate was used as a second-line treatment in cases of intolerance or inadequate response. CONCLUSION: Progestins are effective for the long-term management of adenomyosis symptoms. The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes.

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Outcome instruments

VAS-pain MUSA

Condition tags

mesh:D004412mesh:D004414adenomyosisdysmenorrheadyspareunia

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Progestins Progestins Progestins Progestins Progestins Progestins

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