Clinical efficacy of GnRH-a combined with LNG-IUS in the treatment of refractory adenomyosis by magnetic resonance-guided high intensity focused ultrasound

Objective To explore the clinical effects of Gonadotropin releasing hormone agonist (GnRH-a) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of refractory adenomyosis by magnetic resonance-guided high intensity focused ultrasound (MRgHIFU). Methods 80 patients with refractory adenomyosis admitted to our hospital from April 2015 to June 2017 were randomly divided into observation group and control group. They were treated with MRgHIFU as observation group. LNS-IUS was placed after the third injection of GnRH-a as control group. The uterine volume, pain score, menstrual volume and adverse reactions were compared between the two groups at 3 and 6 months after treatment. Results After 6 months of treatment, the uterine volume of the observation group [(100.23±4.65)cm3] was significantly lower than that of the control group [(145.46±10.23)cm3], with statistically significant difference (t=6.01, P<0.05). After 6 months, the degree of dysmenorrhea in the observation group was significantly lower than that in the control group [(2.12±0.24)point vs (0.27±0.09)point], with statistically significant difference (t=5.21, P<0.05). At 3 and 6 months after treatment, the menstrual volume of the observation group was significantly lower than that of the control group [(64.67±10.12)point vs (96.45±15.12)point, (42.46±11.18)point vs (66.26±12.48)point], with statistically significant difference (t=4.51, P<0.05; t=3.58, P<0.05). The adverse reactions such as vaginal bleeding, hot flashes and night sweats were significantly lower than those in the control group (χ2=3.967, P<0.05). Conclusions As a new non-invasive and refractory treatment of adenomyosis, high intensity focused ultrasound guided by magnetic resonance is safe and effective with less adverse reactions, which is worthy of clinical application. Key words: Adenomyosis; Magnetic resonance imaging; Ultrasonography; Gonadotropin-releasing hormone; Levonorgestrel