Current and Future Medical Therapies for Adenomyosis

Adela G. Cope, Alessandra J Ainsworth, Elizabeth A Stewart
Seminars in reproductive medicine · 2020 · vol. 38(02/03) , pp. 151–156 · doi:10.1055/s-0040-1719016 · PMID:33124017 · W3097245698
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This review examines current and emerging medical therapies for adenomyosis, highlighting the levonorgestrel-releasing IUD and dienogest as effective options, while noting limitations of GnRH agonists and the need for more data on other agents.

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This paper reviews the medical therapies for adenomyosis, noting that there is no approved medical treatment and that evidence is limited by the complexity of nonhistologic diagnosis and frequent coexistence of other gynecologic conditions. Across studies, most outcome data focus on heavy menstrual bleeding, painful menses, and pelvic pain, with major gaps in fertility outcomes, sexual function, and quality of life; it also states there is no disease-specific quality-of-life measure for adenomyosis. The review highlights the levonorgestrel-releasing intrauterine system as the most effective first-line option in available comparisons, dienogest as potentially superior to combined oral contraceptives, long-acting GnRH agonists as second-line but constrained by hypogonadal effects, and aromatase inhibitors as improving bleeding and pain with further research needed. Relevance to endometriosis: the paper is centrally about adenomyosis medical therapies, and it specifically discusses therapies and study contexts that overlap with endometriosis (e.g., GnRH agonist efficacy in adenomyosis and endometriosis and references to related hormone-modulating treatments).

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Abstract

There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence of concomitant gynecologic conditions. Most available evidence focuses on the treatment of heavy menstrual bleeding, painful menses, and pelvic pain. Data evaluating fertility outcomes, sexual function, and quality of life following treatment are lacking. Additionally, there is no disease-specific measure of quality of life for adenomyosis. The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy based on efficacy compared with oral agents, maintenance of steady-state hormonal levels, and contraceptive benefit. In areas where it is marketed, the progestin dienogest appears superior to combined oral contraceptives. Long-acting gonadotropin-releasing hormone agonists are effective and should be considered second-line therapy but are limited by hypogonadal effects. Additional data regarding oral gonadotropin-releasing hormone antagonists are required. While aromatase inhibitors demonstrate improvement in heavy menstrual bleeding and pelvic pain, further research is needed to determine their role in the management of adenomyosis. Progesterone receptor modulators may have a role for this disease if released again to market with appropriate safety parameters. Finally, modulation of prolactin and/or oxytocin may provide novel nonsteroidal treatment options.
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Abstract

There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence of concomitant gynecologic conditions. Most available evidence focuses on the treatment of heavy menstrual bleeding, painful menses, and pelvic pain. Data evaluating fertility outcomes, sexual function, and quality of life following treatment are lacking. Additionally, there is no disease-specific measure of quality of life for adenomyosis. The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy based on efficacy compared with oral agents, maintenance of steady-state hormonal levels, and contraceptive benefit. In areas where it is marketed, the progestin dienogest appears superior to combined oral contraceptives. Long-acting gonadotropin-releasing hormone agonists are effective and should be considered second-line therapy but are limited by hypogonadal effects. Additional data regarding oral gonadotropin-releasing hormone antagonists are required. While aromatase inhibitors demonstrate improvement in heavy menstrual bleeding and pelvic pain, further research is needed to determine their role in the management of adenomyosis. Progesterone receptor modulators may have a role for this disease if released again to market with appropriate safety parameters. Finally, modulation of prolactin and/or oxytocin may provide novel nonsteroidal treatment options. Publication History Article published online: 29 October 2020 © 2020. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA -

References

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Condition tags

mesh:D004412adenomyosis

MeSH descriptors

Adenomyosis Hormone Antagonists Levonorgestrel Nandrolone Adenomyosis Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Hormone Antagonists Humans Levonorgestrel Menorrhagia Menorrhagia Menorrhagia Nandrolone Nandrolone Pain Measurement Quality of Life

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