From the Guidelines
Medical management of adenomyosis should prioritize the use of progestin IUDs, such as the levonorgestrel intrauterine system, due to their local mechanism of action, lower levels of systemic hormones, and significant improvement in pain and bleeding symptoms, as demonstrated in a recent randomized controlled trial 1. When managing adenomyosis, the primary goal is to control symptoms, particularly menstrual pain and heavy bleeding.
- Progestin IUDs are clinically favored due to their ability to reduce painful and heavy menstrual bleeding, with a recent study showing significant improvement in symptoms compared to combined oral contraceptives 1.
- Combined oral contraceptives can also be effective in reducing symptoms, but may not be as favorable due to higher levels of systemic hormones.
- Additionally, oral GnRH antagonist combinations have been shown to be effective in treating heavy menstrual bleeding, even in the presence of concomitant adenomyosis, as demonstrated in a pooled analysis of randomized controlled trials 1. Key considerations in medical management include:
- Symptom severity
- Desire for future fertility
- Side effect profiles
- Patient preferences It is essential to note that these therapies may not address associated bulk symptoms, and treatment choices should be individualized based on patient-specific factors.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medical Management of Adenomyosis
The medical management of adenomyosis involves various treatment options to alleviate symptoms such as heavy menstrual bleeding, dysmenorrhoea, and pelvic pain.
- Hormonal treatments, including continuous use of oral contraceptive pills, high-dose progestins, selective oestrogen receptor modulators, and selective progesterone receptor modulators, can temporarily induce regression of adenomyosis and improve symptoms 2, 3.
- The levonorgestrel-releasing intrauterine device is an effective treatment option for controlling abnormal uterine bleeding and reducing uterine volume in the long-term management of adenomyosis 2, 3, 4, 5.
- Gonadotropin-releasing hormone analogues can be used to improve fertility outcomes in infertile women with adenomyosis, and are also effective in reducing symptoms 3, 4.
- Progestins, such as dienogest, danazol, and norethindrone acetate, have an antiproliferative and anti-inflammatory effect, making them useful in the medical management of adenomyosis to control pain symptoms 3, 4.
- Aromatase inhibitors and selective progesterone receptor modulators are being researched as potential new treatments for adenomyosis, although more studies are needed to determine their efficacy 3, 4.
Treatment Options
The choice of treatment for adenomyosis depends on various factors, including the severity of symptoms, desire for fertility, and patient preferences.
- The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy, based on efficacy and contraceptive benefits 4.
- Long-acting gonadotropin-releasing hormone agonists are effective, but limited by hypogonadal effects, and should be considered second-line therapy 4.
- Oral gonadotropin-releasing hormone antagonists and progesterone receptor modulators may have a role in the management of adenomyosis, although more research is needed 4.
Hormonal Contraceptives
Hormonal contraceptives have been used as a cost-effective medical treatment for adenomyosis, particularly estrogen/progestogen combinations and progestogen-only therapy 6.
- These treatments have been shown to be effective in controlling endometriosis/adenomyosis-related symptoms and minimizing recurrence rates 6.