From the Guidelines
Treatment for adenomyosis should prioritize medical management, including hormonal options and nonsteroidal anti-inflammatory drugs (NSAIDs), as the initial therapy, with uterine artery embolization (UAE) or surgical options considered for patients who fail conservative measures or have severe symptoms. According to the most recent study 1, medical management or UAE is usually appropriate for the initial therapy for a reproductive age patient with uterine fibroids and concurrent adenomyosis, symptomatic with heavy uterine bleeding or bulk symptoms. Some key points to consider in the treatment of adenomyosis include:
- Medical treatments, such as combined oral contraceptives, progestin-only pills, or the levonorgestrel intrauterine device (Mirena), can reduce bleeding and pain by thinning the endometrium 2.
- NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) can provide pain relief 2.
- GnRH agonists like leuprolide acetate (3.75mg monthly injection) may be used for temporary symptom relief, though they can cause menopausal symptoms and bone loss if used beyond 6-12 months 2.
- UAE has shown early success in controlling the symptoms of bleeding with adenomyosis, with long-term durability of this success being questionable, but recent data showing durability in symptom control 3, 4.
- For women who have completed childbearing and have severe symptoms, hysterectomy provides definitive treatment. The choice of treatment depends on the woman's age, symptom severity, desire for future pregnancy, and personal preferences, with the goal of reducing inflammation, suppressing hormonal stimulation of the abnormal tissue, or removing affected tissue. As noted in the study 3, UAE for adenomyosis should be considered for patients presenting with symptomatic adenomyosis or concomitant adenomyosis and uterine leiomyomata, with a recent meta-analysis reporting short-term and long-term improvement in symptoms in 94% and 85%, respectively. Ultimately, the treatment of adenomyosis requires a personalized approach, taking into account the individual patient's needs and circumstances, with the most recent and highest quality evidence guiding the decision-making process 1.
From the Research
Treatment Options for Adenomyosis
The treatment options for adenomyosis can be categorized into medical and surgical approaches.
- Medical treatments are effective in improving symptoms such as pain, abnormal uterine bleeding, and infertility 5, 6, 7, 8.
- Hormonal treatments, including progestins, oral contraceptives, and gonadotropin-releasing hormone analogues, are commonly used to control pain symptoms and abnormal uterine bleeding in adenomyosis 5, 6, 7, 8.
- Non-hormonal treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), can be used to control pain associated with adenomyosis, especially in patients with recent fertility requirements 8.
- The levonorgestrel-releasing intrauterine device is extremely effective in resolving abnormal uterine bleeding and reducing uterine volume in a long-term management plan 5, 6, 8.
Surgical Treatment Options
- Hysterectomy remains the only definitive treatment for adenomyosis, but conservative surgical treatments are becoming more popular, especially in patients who wish to preserve their uterus 9.
- Cytoreductive surgery for adenomyosis can be effective in ameliorating abnormal uterine bleeding and pelvic pain, and reducing uterine volume, but it should be performed by experienced surgeons in dedicated centers 9.
- Radiological procedures, such as uterine artery embolization (UAE) and high-intensity focused ultrasound (HIFU), may be proposed in cases where medical therapy is ineffective 9.
Long-Term Management
- Progestins, such as dienogest, levonorgestrel, and drospirenone, are effective for the long-term management of adenomyosis symptoms, but may require switching between different progestins or routes of administration due to side effects or contraception needs 6.
- The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes and improving patient satisfaction 6.