Classified conservative treatment for adenomyosis:a preliminary observation

Objective To evaluate the clinical outcomes of classified conservative treatment for adenomyosis using levonorgestrel-releasing intrauterine system(LNG-IUS)combined with gonadotropin-releasing hormone agonist(GnRHa).Methods A total of 92 patients diagnosed as adenomyosis between January 2010 and December 2013 were treated by using LNG-IUS or LNG-IUS combined with GnRHa.Of them,11 patients with mildly enlarged uterus(group A)underwent solo LNG-IUS,other 20 patients with mildly enlarged uterus(group B)received LNG-IUS combined with GnRHa,39 with moderately enlarged uterus(group C)and 13 with severely enlarged uterus(group D)also received combined treatment,and other 9 with severely enlarged uterus were treated only by GnRHa(group E).Follow-up was taken at the following time points:pretreatment(T0),1month(T1),3months(T3)and 6months(T4)after injection of GnRHa,1month(t1),3months(t2),6months(t3),12months(t4),24months(t5)and 36months(t6)after placing LNG-IUS.During follow-up,the size of uterus and serum CA125 were measured,and dysmenorrheal,menstrual cycles,and continuous use of LNG-IUS were recorded.Results Compared with that at T0,uterus in group A at t3 to t5,in group B at T1(t1),T2,T3(t2),and t3 to t5,in group C at T1 to T3,and t1 to t4,in group D at T1 to T4,and t1 to t3 were significantly decreased(all P0.05).Compared with that at T0,visual analogue scale(VAS)score in group A at t2 to t6,in group B and C at t1 to t6,in group D at t1 to t4 were also significantly decreased(all P0.05).Dysmenorrhea were inhibited at least3 years in group A、B and C,while less than 2years in group D.VAS score in group B were significantly less than those in group A at t1 and t2(both P0.05).Compared with that at T0,serum level of CA125 in group A and B at t2 and t3,in group C at T3,t2 and t3,in group D at T3,t4,t2 and T3 were significantly decreased(all P0.05).Serum level of CA125 in group A at t3 was significantly lower than that at t2(P0.05).Serum CA125 level in group C at t2 was significantly lower than that at T3(P0.05).Serum CA125 level in group B,C and D at t2 were significantly lower than those in group A(all P0.05).Serum CA125 level in group B at t3 was significantly lower than that in group D(P0.05).During follow-up,LNG-IUS fell off in 5patients(one in group A,two in group C and another two in group D)and moved down in 6patients(one in group A,another one in group B,two in group C and another two in group D).Treatment plan was changed in 15patients(one in group A,four in group C and 10 in group D).Conclusion LNG-IUS refers to the adenomyosis patients with normal or mildly enlarged uterus and mild symptoms.For those with moderately enlarged uterus,GnRHa can be used at first for 3months and then LNGIUS is placed.For those with severely enlarged uterus,the over-all effect of GnRHa combined LNG-IUS treatment is not satisfying,so patients should be suggested to undergo conservative surgical treatment followed by GnRHa and LNG-IUS.(Shanghai Med J,2015,38:239-244)