Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review

Purpose Medical management of adenomyosis largely revolves around symptom management, with very few drugs having received regulatory approval for the disease. However, the level of evidence supporting the use of pharmacological interventions is low, making it difficult to establish their efficacy in the treatment of adenomyosis. Hence, the aim of our systematic review is to identify the strength of evidence currently available and evaluate the effectiveness of different medical interventions in the management of adenomyosis.

The search was performed in MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov. Articles published between 1 January 2010 and 30 November 2020 were considered. Randomized controlled trials and observational studies that assessed the efficacy of medical interventions in patients with adenomyosis were included. The quality of the data was analyzed using RevMan 5.3 software.

LNG-IUS (levonorgestrel intrauterine system), dienogest and gonadotropin-releasing hormone (GnRH) analogues were effective in reducing pain, uterine volume and menstrual bleeding. However, these data were largely obtained in the non-trial setting and were fraught with issues that included patient selection, short duration of therapy, small sample size, and limited long-term safety and effectiveness data.

Although LNG-IUS, dienogest and GnRH analogues have better evidence for effectiveness in adenomyosis, the need of the hour is to thoroughly evaluate other novel molecules for adenomyosis using well-designed randomized controlled trials. Similar content being viewed by others

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We would like to thank SRM Institute of Science & Technology for administrative support. Author information Authors and Affiliations Contributions The study was conceptualized and designed by MG, KKR and JJA. The literature search and title and abstract review were performed by JJA, KKR, SAS and HPS. MG and MS conducted the data analysis. MG, MS and AP carried out the process of abstracting and quality assessment of the included studies. All authors contributed to the writing and revision of the final manuscript. The final manuscript was read and approved by all authors. Ethics declarations Ethical approval Not applicable. Conflict of interest All the authors have declared that there is no conflict of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Rathinam, K.K., Abraham, J.J., S, H.P. et al. Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review. Eur J Clin Pharmacol 78, 531–545 (2022). https://doi.org/10.1007/s00228-021-03256-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00228-021-03256-0