An integrated approach to the treatment of pelvic pain associated with adenomyosis

Т. Ф Татарчук, L.V. Kaluginа, A.О. Danylova, К.С. Павлова
In: REPRODUCTIVE ENDOCRINOLOGY · 2021 · pp. 53–60 · doi:10.18370/2309-4117.2021.59.53-60 · W3185462314
article OA: diamond CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This study found that adding L-arginine to dydrogesterone treatment significantly reduced pelvic pain in women with adenomyosis compared to dydrogesterone alone.

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

This study evaluated whether adding a nitric oxide donor (L-arginine; Tivortin) to dydrogesterone improves pelvic pain in 63 women diagnosed with adenomyosis, assessed using the Visual Analogue Scale, McGill Pain Questionnaire, and SF-36 at baseline, after 1 and 3 months of treatment, and again 3 months after stopping. Both groups achieved therapeutic effects, but the group receiving dydrogesterone plus L-arginine had a significant reduction in pelvic pain after 3 months, with no pain recurrence, whereas the standard dydrogesterone-only group had a more prolonged progestogen intake; further improvement occurred in the standard group at 6 months follow-up. The main caveat is that the paper provides limited detail on study design beyond simple randomization and does not explicitly describe blinding, control of concomitant factors, or adverse events. This paper is centrally about adenomyosis — it tests nitric oxide donor (L-arginine) as an add-on to dydrogesterone for pelvic pain in adenomyosis, directly addressing dysmenorrhoea and intermenstrual pelvic pain.

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Abstract

Dysmenorrhoea and intermenstrual pelvic pain are the most common symptoms of clinical manifestations of adenomyosis, which significantly impair the quality of women’s life. Adequate and long-term pain correction and alternative therapeutic approaches became extremely important for patients with adenomyosis during the COVID-19 pandemic. Research objective: to examine the clinical efficacy of nitric oxide donor (L-arginine) in the complex treatment of pelvic pain syndrome associated with adenomyosis.Materials and methods. The study included 63 women diagnosed with adenomyosis. Patients were divided into 2 groups by simple randomization: I (D) group (n = 31) received dydrogesterone 30 mg from 5 to 25 days of the menstrual cycle, II (D+T) group (n = 32) in addition to dydrogesterone received a nitric oxide donor L-arginine (Тivortin) according to the scheme. Pelvic pain was assessed before treatment with a Visual Analogue Scale and a McGill Pain Questionnaire, and an assessment of the overall pain impact on women's well-being was based on the SF-36 Health Status Survey. The effectiveness of pelvic pain therapy was assessed after the first and third months of treatment, as well as three months after the end of therapy with the above methods.Results. Researchers achieved a therapeutic effect in the treatment of chronic pelvic pain in both study groups, but in group II (D + T) after 3 months of treatment there was a significant reduction in pelvic pain, while patients of the standard therapy group have prolonged progestogen intake. There was a further improvement in the clinical condition in group I (D) after 6 months of follow-up, as well as no recurrence of pain in group II (D + T).Conclusions. The results of study demonstrate a significant effect of Tivortin as part of complex therapy on the rate of achievement and duration of therapeutic effect in the treatment of pelvic pain associated with adenomyosis.

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Condition tags

adenomyosischronic_pelvic_paindysmenorrhea

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