The efficacy of medical treatment for adenomyosis after adenomyomectomy

Qiuju Li, Li Q, Ming Yuan, Ni Li, Li N, Zhen Q, Qianwei Zhen, Chang Chen, Chen C, Wang G, Guoyun Wang
Journal of Obstetrics and Gynaecology Research · 2020 · vol. 46(10) , pp. 2092–2099 · doi:10.1111/jog.14376 · PMID:32725682 · W3045824985
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This study found that gonadotropin-releasing hormone agonist plus a levonorgestrel-releasing intrauterine system after adenomyomectomy significantly reduced adenomyosis symptom recurrence and prolonged recurrence-free survival compared to adenomyomectomy alone.

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Abstract

AIMS: To compare the efficacy of gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-a + levonorgestrel-releasing intrauterine system (LNG-IUS) after adenomyomectomy for improved adenomyosis-associated symptoms. METHODS: Overall, 193 patients with adenomyosis included in this study were categorized into three groups: adenomyomectomy (n = 57, group 1), adenomyomectomy + GnRH-a (n = 83, group 2) and adenomyomectomy + GnRH-a + LNG-IUS (n = 53, group 3). Visual Analog Scale (VAS) scores and uterine volumes were determined to evaluate the severity of adenomyosis. Dysmenorrhea improvement and uterine volume were the main outcomes. RESULTS: The VAS scores of all patients reduced from 7.3 (6.0, 8.5) to 0 (0, 0.6) at the 6 months after surgery, which were significantly higher in group 1 compared to other groups (P < 0.05). In groups 1, 2 and 3, there were 14, 7 and 4 patients, respectively, who suffered dysmenorrhea recurrence. The mean recurrent-free-survival (RFS) was 51.6 ± 2.4, 58.0 ± 1.2 and 58.3 ± 1.0 months, respectively, which was significantly shorter in group 1 (P < 0.05). The dysmenorrhea recurrences were 26.3%, 6.1%, 5.9% in groups 1, 2 and 3, respectively, at the 36 months, which was significantly higher in group 1 (P < 0.01). Significantly decreased uterine volumes were observed in all patients from 222.2 (147.6, 350.4) to 77.0 (65.9, 94.1) mL (P < 0.05) at the 6 month after surgery. CONCLUSION: Treatment GnRH-a and LNG-IUS after surgery could significantly reduce the recurrence and prolong the RFS. It seemed that the use of LNG-IUS was beneficial for a lower recurrence in long-term follow-up.

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Condition tags

dysmenorrheaadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Intrauterine Devices, Medicated Intrauterine Devices, Medicated Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Female Humans Humans Levonorgestrel Levonorgestrel Treatment Outcome Treatment Outcome

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (30)

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