Risk factors and countermeasures for abnormal uterine bleeding during dienogest therapy for adenomyosis: a review

Shiyu Zhang, Hua Duan
Frontiers in reproductive health · 2025 · vol. 7 , pp. 1550814 · doi:10.3389/frph.2025.1550814 · PMID:40662092 · W4411956444
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review examines risk factors for abnormal uterine bleeding during dienogest therapy for adenomyosis and advances in management strategies to improve patient adherence.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This review focuses on adenomyosis patients treated with dienogest (DNG), examining why some develop abnormal uterine bleeding (AUB) and identifying risk factors that predict early discontinuation or poor adherence, along with proposed countermeasures during long-term therapy. Across cited retrospective and prospective cohorts, younger age (<38), higher baseline dysmenorrhea severity (higher VAS scores), greater pretreatment menstrual blood loss (PBAC), and larger uterine morphometric measures (e.g., uterine volume/major axis/myometrial thickness thresholds) were associated with severe AUB and treatment interruption; anemia severity (with Hb <8 g/dl described as contraindicated) and higher serum CA-125 and mid-treatment estradiol levels were also linked to worse outcomes. A key limitation is that many supporting data come from small studies (e.g., cohorts with ~17–61 participants) and the review synthesizes findings across heterogeneous designs rather than providing a single new trial, while some recommendations are framed as consensus or guideline-based criteria. Relevance to endometriosis: the paper explicitly compares adenomyosis to endometriosis as both estrogen-dependent disorders, which motivates review of DNG’s bleeding risk—though its main focus is risk factors and countermeasures for DNG-associated AUB in adenomyosis. This paper is centrally about adenomyosis — specifically, risk factors for and management strategies to address abnormal uterine bleeding during dienogest therapy.

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Abstract

Adenomyosis, an estrogen-dependent disorder, requires long-term therapy as current treatments (GnRH agonists, danazol, etc.) show symptom recurrence post-discontinuation. Dienogest (DNG), a selective progesterone receptor agonist, effectively reduces adenomyosis-related pain but causes abnormal uterine bleeding (AUB) in some patients, likely due to pseudodecidual breakthrough bleeding, significantly impacting treatment compliance. This review examines risk factors for DNG-associated AUB and advances in management strategies to improve patient adherence during prolonged therapy.

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Outcome instruments

VAS-pain

Condition tags

adenomyosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (33)

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