Pharmacological Treatment for Symptomatic Adenomyosis: A Systematic Review

Cristina Laguna Benetti‐Pinto, Ticiana Aparecida Alves de Mira, Daniela Angerame Yela, Cassia Raquel Teatin-Juliato, Cássia Raquel Teatin Juliato, Luiz Gustavo Oliveira Brito
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2019 · vol. 41(09) , pp. 564–574 · doi:10.1055/s-0039-1695737 · PMID:31546278 · W2977150576
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Abstract

OBJECTIVE: To assess the efficacy of non-surgical treatment for adenomyosis. DATA SOURCES: A search was performed by two authors in the Pubmed, Scopus, and Scielo databases and in the grey literature from inception to March 2018, with no language restriction. SELECTION OF STUDIES: We have included prospective randomized studies for treating symptomatic women with adenomyosis (abnormal uterine bleeding and/or pelvic pain) diagnosed by ultrasound or magnetic resonance imaging. DATA COLLECTION: Studies were primarily selected by title and abstract. The articles that were eligible for inclusion were evaluated in their entirety, and their data was extracted for further processing and analysis. DATA SYNTHESIS: From 567 retrieved records only 5 remained for analysis. The intervention groups were: levonorgestrel intrauterine system (LNG-IUS)(n = 2), dienogest (n = 2), and letrozole (n = 1). Levonorgestrel intrauterine system was effective to control bleeding when compared to hysterectomy or combined oral contraceptives (COCs). One study assessed chronic pelvic pain and reported that LNG-IUS was superior to COC to reduce symptoms. Regarding dienogest, it was efficient to reduce pelvic pain when compared to placebo or goserelin, but less effective to control bleeding than gonadotropin-releasing hormone (GnRH) analog. Letrozole was as efficient as GnRH analog to relieve dysmenorrhea and dyspareunia, but not for chronic pelvic pain. Reduction of uterine volume was seen with aromatase inhibitors, GnRH analog, and LGN-IUD. CONCLUSION: Levonorgestrel intrauterine system and dienogest have significantly improved the control of bleeding and pelvic pain, respectively, in women with adenomyosis. However, there is insufficient data from the retrieved studies to endorse each medication for this disease. Further randomized control tests (RCTs) are needed to address pharmacological treatment of adenomyosis.

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Condition tags

adenomyosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Adenomyosis Adenomyosis Aromatase Inhibitors Aromatase Inhibitors Contraceptive Agents Contraceptive Agents Female Hormone Antagonists Hormone Antagonists Humans Intrauterine Devices, Medicated Menstruation Disturbances Menstruation Disturbances Uterus Uterus

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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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