Results of dienogest treatment and its discontinuation in patients with symptomatic adenomyosis: a prospective cohort study

Shen M, Minhong Shen, Xishi Liu, Liu X, Ding Ding, Sun-Wei Guo, Sun‐Wei Guo
Reproductive biomedicine online · 2025 · vol. 51(2) , pp. 104880 · doi:10.1016/j.rbmo.2025.104880 · PMID:40582022 · W4408148657
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This prospective cohort study investigated the efficacy and side effects of dienogest treatment and its discontinuation in patients with symptomatic adenomyosis.

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Abstract

RESEARCH QUESTION: Do any factors in patients with symptomatic adenomyosis contribute to the greater alleviation of dysmenorrhoea and heavy menstrual bleeding (HMB) after treatment with dienogest, and what are the risk factors, if any, for recurrence if the dienogest treatment is discontinued? DESIGN: One hundred and twenty-five premenopausal patients diagnosed with adenomyosis by transvaginal ultrasound (TVUS), magnetic resonance imaging, or both. All patients underwent an ultrasound elastographic (TVESG) examination, and lesional stiffness was measured. All patients took dienogest (either branded or generic) for 6 months and were then instructed to stop for 3 months. Every 3 months after the start of treatment until 3 months after stopping, TVUS and TVESG examinations and symptoms were evaluated. Uterine size, lesional stiffness and haemoglobin levels were also measured. RESULTS: Treatment with dienogest resulted in symptom relief. Patients with more severe dysmenorrhoea or co-existing endometrioma had greater improvement in dysmenorrhoea (both P ≤ 0.042), but those with diffuse adenomyosis and co-existing fibroids responded less well. Discontinuation of the treatment causes relapse in some patients, and more severe symptoms and higher lesional stiffness were identified as factors for symptom recurrence (both P ≤ 0.017). CONCLUSIONS: Patients with adenomyosis with more severe dysmenorrhoea and HMB may benefit most from dienogest treatment, but also face higher recurrence risk if the treatment is discontinued, especially when their lesions are highly fibrotic. Therefore, only patients with severe dysmenorrhoea, severe HMB and higher lesional stiffness may require long-term medication, whereas others may take a break from daily medications.

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Condition tags

dysmenorrheaadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

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.

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