Low-dose gonadotropin-releasing hormone agonist therapy (draw-back therapy) for successful long-term management of adenomyosis associated with cerebral venous and sinus thrombosis from low-dose oral contraceptive use

T Matsushima, Akira S, S Akira, Shigeo Akira, Asakura H, H Asakura, Hirofumi Asakura, Toshiyuki Takeshita, T Takeshita, Takeshita T
Clinical and experimental obstetrics & gynecology · 2017 · vol. 44(1) , pp. 143–145 · doi:10.12891/ceog3214.2017 · PMID:29714885 · W3024292692
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

A GnRH agonist "draw-back therapy" successfully managed adenomyosis and prevented recurrent cerebral venous and sinus thrombosis in a patient who previously experienced thrombosis while on low-dose oral contraceptives.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This paper describes a single 38-year-old nulligravida case with uterine adenomyosis diagnosed by ultrasound and MRI, who was treated with low-dose estrogen-progestin oral contraceptives after presenting with dysmenorrhea and postmenstrual lower abdominal pain. After 18 months of oral contraceptive use, she developed cerebral venous and sinus thrombosis; oral contraceptives were stopped and antiplatelet therapy was given, but after six months her pain worsened and she then received long-term low-dose gonadotropin-releasing hormone agonist “draw-back” therapy. During 2.5 years of therapy, uterine enlargement was not observed, her abdominal pain resolved, her bone density remained within normal limits, and CVST did not recur with no other thromboses. As a case report, it is limited to one patient and does not establish generalizable efficacy or safety. This paper is centrally about endometriosis or adenomyosis — it focuses on long-term management of adenomyosis using low-dose GnRHa draw-back therapy in the context of cerebral venous and sinus thrombosis.

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Abstract

The authors report a case of cerebral venous and sinus thrombosis (CVST) in a patient receiving a low-dose estrogen-progestin combination (oral contraceptives, OCs) for uterine adenomyosis. She was switched to gonadotropin-releasing hormone agonist (GnRHa) draw-back therapy, which was successfully administered long-term. CASE: The patient was a 38-year-old nulligravida with a history of smoking. She presented to this hospital with dysmenorrhea and postmenstrual lower abdominal pain. Adenomyosis was diagnosed using ultrasound and magnetic resonance imaging. She was instructed to stop smoking and was administered low-dose OCs. CVST occurred 18 months later. OC therapy was halted, and only antiplatelet therapy was administered. After six months, her chief complaint symptoms intensified, therefore GnRHa draw-back therapy was administered after obtaining informed consent. No uterine enlargement was observed, and the abdominal pain resolved. During 2.5 years of therapy, her bone density levels remained within normal limits. CVST did not recur and no other thromboses were observed.
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Abstract

The authors report a case of cerebral venous and sinus thrombosis (CVST) in a patient receiving a low-dose estrogen-progestin combination (oral contraceptives, OCs) for uterine adenomyosis. She was switched to gonadotropin-releasing hormone agonist (GnRHa) draw-back therapy, which was successfully administered long-term. Case: The patient was a 38-year-old nulligravida with a history of smoking. She presented to this hospital with dysmenorrhea and postmenstrual lower abdominal pain. Adenomyosis was diagnosed using ultrasound and magnetic resonance imaging. She was instructed to stop smoking and was administered low-dose OCs. CVST occurred 18 months later. OC therapy was halted, and only antiplatelet therapy was administered. After six months, her chief complaint symptoms intensified, therefore GnRHa draw-back therapy was administered after obtaining informed consent. No uterine enlargement was observed, and the abdominal pain resolved. During 2.5 years of therapy, her bone density levels remained within normal limits. CVST did not recur and no other thromboses were observed.

Keywords

- Adenomyosis - Cerebral venous and sinus thrombosis - Low-dose gonadotropin-releasing hormone agonist therapy - Low-dose oral contraceptive

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Condition tags

adenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Contraceptives, Oral, Hormonal Fertility Agents, Female Leuprolide Sinus Thrombosis, Intracranial Adenomyosis Adult Contraceptives, Oral, Hormonal Female Fertility Agents, Female Humans Leuprolide Sinus Thrombosis, Intracranial

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 (15)

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