Hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis

Adenomyosis is a uterine disorder marked by symptoms such as pelvic pain, abnormal uterine bleeding (AUB), and infertility. The purpose of this study was to assess the effectiveness and patient outcomes of hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis. The aim of this study was to evaluate the effectiveness and patient outcomes of hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis.

This prospective observational study included 85 patients with symptomatic adenomyosis treated with hormonal therapy (n=45) or hysterectomy (n=40) at Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2022 to 2023. Inclusion criteria were adult females aged 20 years and above, while those with other gynecological disorders or severe comorbidities were excluded. Data on demographic characteristics, symptom relief, and patient satisfaction were analyzed using statistical package for the social sciences (SPSS) version 22.0, employing both descriptive and inferential statistics.

Most patients (n=85) were aged 40-49 years, with 55.6% receiving hormonal therapy. Hormonal therapy was used in 52.9% of cases, slightly surpassing hysterectomy at 47.1%. Treatment outcomes showed that 75.0% of hysterectomy patients experienced complete symptom relief, while only 44.4% in the hormonal therapy group reported the same, and 70.0% of hysterectomy patients were very satisfied compared to 33.3% in the hormonal therapy group. Hysterectomy patients had a shorter hospital stay, with 25.0% discharged within 2-3 days compared to 11.1% of hormonal therapy patients.

Hysterectomy provides superior symptom relief and patient satisfaction compared to hormonal therapy in the management of symptomatic adenomyosis. Metrics

Abbott JA. Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2017;40:68-81. DOI: https://doi.org/10.1016/j.bpobgyn.2016.09.006 Levy G, Dehaene A, Laurent N, Lernout M, Collinet P, Lucot J-P, et al. An update on adenomyosis. Diagn Interv Imaging. 2013;94(1):3-25. DOI: https://doi.org/10.1016/j.diii.2012.10.012 Genc M, Genc B, Cengiz H. Adenomyosis and accompanying gynecological pathologies. Arch Gynecol Obstet. 2015;291(4):877-81. DOI: https://doi.org/10.1007/s00404-014-3498-8 Devlieger R, D’Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003;9(2):139-47. DOI: https://doi.org/10.1093/humupd/dmg010 Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics. 2005;25(1):21-40. DOI: https://doi.org/10.1148/rg.251045060 Naftalin J, Hoo W, Pateman K, Mavrelos D, Foo X, Jurkovic D. Is adenomyosis associated with menorrhagia? Hum Reprod. 2014;29(3):473-9. DOI: https://doi.org/10.1093/humrep/det451 Azziz R. Adenomyosis: current perspectives. Obstet Gynecol Clin North Am. 1989;16(1):221-35. DOI: https://doi.org/10.1016/S0889-8545(21)00148-0 de Bruijn AM, Lohle PN, Huirne JA, de Vries J, Twisk M, QUESTA-Trial Group, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic adenomyosis: Protocol for the randomized QUESTA trial. JMIR Res Protoc. 2018;7(3):e47. DOI: https://doi.org/10.2196/resprot.8512 Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod. 2010;25(5):1177-82. DOI: https://doi.org/10.1093/humrep/deq034 Lazzeri L, Di Giovanni A, Exacoustos C, Tosti C, Pinzauti S, Malzoni M, et al. Preoperative and postoperative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis. Reprod Sci. 2014;21(8):1027-33. DOI: https://doi.org/10.1177/1933719114522520 Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril. 2018;109(3):398-405. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.013 Bahamondes L, Bahamondes MV, Monteiro I. Levonorgestrel-releasing intrauterine system: uses and controversies. Expert Rev Med Devices. 2008;5(4):437-45. DOI: https://doi.org/10.1586/17434440.5.4.437 Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-93. DOI: https://doi.org/10.1016/j.contraception.2008.11.004 Fedele L, Bianchi S, Frontino G. Hormonal treatments for adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2008;22(2):333-9. DOI: https://doi.org/10.1016/j.bpobgyn.2007.07.006 Goodwin SC, McLucas B, Lee M, Chen G, Perrella R, Vedantham S, et al. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol. 1999;10(9):1159-65. DOI: https://doi.org/10.1016/S1051-0443(99)70213-7 Park Y, Kim MD, Jung DC, Lee SJ, Kim G, Park SI. Can measurement of apparent diffusion coefficient before treatment predict the response to uterine artery embolization for adenomyosis? Eur Radiol. 2015;25(5):1303-9. DOI: https://doi.org/10.1007/s00330-014-3504-3 Smeets AJ, Nijenhuis RJ, Boekkooi PF, Vervest HAM, van Rooij WJ, Lohle PNM. Long-term follow-up of uterine artery embolization for symptomatic adenomyosis. Cardiovasc Radiol. 2012;35(4):815-9. DOI: https://doi.org/10.1007/s00270-011-0203-1 Roy DD, Modak DBS, Nag DAC, Ghosh PDT. Comparison between LNG ius vs hysterectomy in management of endometriosis. South East Eur J Public Health. 2024;425-30. DOI: https://doi.org/10.70135/seejph.vi.1192 Atlihan U, Ertan B, Özgözen E, Güney M. Comparison of patients with adenomyosis detected in hysterectomy material and patients with other benign pathologies: Retrospective study. Türk üreme tıbbı ve cerrahisi derg. 2024;8(2):54-62. DOI: https://doi.org/10.24074/tjrms.2023-100472 Matsushima T, Akira S, Fukami T, Yoneyama K, Takeshita T. Efficacy of hormonal therapies for decreasing uterine volume in patients with adenomyosis. Gynecol Minim Invasive Ther. 2018;7(3):119-23. DOI: https://doi.org/10.4103/GMIT.GMIT_35_18 Ozdegirmenci O, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril. 2011;95(2):497-502. DOI: https://doi.org/10.1016/j.fertnstert.2010.10.009 Yavuzcan A, Başbuğ A, Baştan M, Çağlar M, Özdemir İ. The effect of adenomyosis on the outcomes of laparoscopic hysterectomy. J Turk Ger Gynecol Assoc. 2016;17(3):150-4. DOI: https://doi.org/10.5152/jtgga.2016.16073