From the Guidelines
GnRH agonists, such as leuprolide or goserelin, are effective options for managing adenomyosis symptoms, despite the misspelling of "Agystin" in the question. These medications work by temporarily suppressing estrogen production, which can reduce heavy bleeding and pain associated with adenomyosis. Typical treatment involves monthly injections for 3-6 months, though extended use (up to 12 months) may be considered with add-back hormone therapy to prevent bone loss, as suggested by the ACOG committee 1. Other effective options include hormonal contraceptives (continuous combined oral contraceptives or levonorgestrel IUD), progestins, or tranexamic acid for bleeding control. These medications provide symptom relief rather than cure, as adenomyosis symptoms often return when treatment stops. For permanent resolution, hysterectomy remains the definitive treatment. Side effects of GnRH agonists include menopausal symptoms like hot flashes, vaginal dryness, and potential bone density loss with prolonged use, which is why treatment duration is typically limited unless add-back therapy is used. Additionally, uterine artery embolization (UAE) has been shown to improve quality of life and symptom scores in patients with adenomyosis and fibroids who fail conservative measures and desire uterus-preserving therapy, with a recent meta-analysis reporting short-term and long-term improvement in symptoms in 94% and 85% of patients, respectively 1. However, comprehensive data on fertility and pregnancy after UAE is lacking, and patients should be counseled accordingly. Key considerations in managing adenomyosis include:
- Symptom relief with GnRH agonists or other hormonal therapies
- Potential for side effects with prolonged use of GnRH agonists
- Uterine artery embolization as a uterus-preserving alternative for patients who fail conservative measures
- Hysterectomy as a definitive treatment option for permanent resolution of symptoms.
From the Research
Adenomyosis Treatment Options
- Adenomyosis is a common benign uterine disorder that can cause symptoms such as dysmenorrhea, dyspareunia, abnormal uterine bleeding (AUB), and infertility 2, 3.
- The treatment of adenomyosis can be complex and may involve medical, surgical, or radiological approaches 2, 4.
Medical Treatment
- Hormonal drugs, such as progestogens and GnRH agonists, are commonly used to treat adenomyosis and can be effective in reducing symptoms and uterine volume 2, 5.
- Levonorgestrel-releasing intrauterine systems have also shown some effectiveness in treating adenomyosis 3.
Surgical Treatment
- Hysterectomy is a definitive treatment for adenomyosis, but conservative surgical treatments, such as cytoreductive surgery, can also be effective in ameliorating symptoms and reducing uterine volume 2.
- Minimally invasive treatments, such as uterine artery embolization (UAE), radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU), can also be effective in reducing symptoms 4, 6.
Agystin (likely a misspelling of a medication)
- There is no direct evidence on the effectiveness of Agystin for managing adenomyosis symptoms, possibly due to the misspelling of the medication.
- However, GnRH agonists, which may be the intended medication, have been shown to be effective in treating adenomyosis symptoms 5.