From the Guidelines
Medical management of adenomyosis should prioritize progestin IUDs as the first-line treatment 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.
Medical Management Options
The primary goal of medical management in adenomyosis is to control symptoms such as menstrual pain and heavy bleeding. The treatment options can be categorized into several groups:
- Hormonal therapies: These include progestin IUDs, combined oral contraceptives, and other progestins like oral medroxyprogesterone acetate or depot medroxyprogesterone acetate injections.
- Non-hormonal therapies: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be used to reduce pain and bleeding during menstruation.
Key Considerations
When choosing a medical management option for adenomyosis, several factors should be considered:
- Symptom severity: The choice of treatment should be guided by the severity of symptoms such as pain and bleeding.
- Desire for future fertility: Some treatments, like GnRH agonists, may impact fertility and should be used cautiously in women who wish to conceive in the future.
- Side effect profiles: The potential side effects of each treatment option should be weighed against the benefits.
- Patient preferences: Patient preferences and values should play a significant role in the decision-making process.
Evidence-Based Recommendations
Recent studies have shown that progestin IUDs are highly effective in reducing painful and heavy menstrual bleeding in women with adenomyosis 1. A randomized controlled trial demonstrated significant improvement in pain and bleeding in women with adenomyosis treated with progestin IUDs compared to combined oral contraceptives 1. Additionally, pooled analysis of randomized controlled trials has shown that the presence of concomitant adenomyosis does not decrease the effectiveness of oral GnRH antagonist combinations in the treatment of heavy menstrual bleeding 1.
Treatment Choice
The choice of treatment should prioritize progestin IUDs due to their efficacy, localized mechanism of action, and lower risk of systemic side effects 1. Other hormonal options, such as combined oral contraceptives or progestins, can be considered based on patient preferences and symptom severity. Non-hormonal options like NSAIDs can be used for symptom management, especially for pain control. In severe cases, GnRH agonists may be considered, but their use is typically limited due to concerns about bone density and potential side effects.
From the Research
Medical Management Options for Adenomyosis
The medical management of adenomyosis involves various treatment options to alleviate symptoms such as pain, abnormal uterine bleeding, and infertility.
- Hormonal Treatments: Hormonal treatments, including progestins, oral contraceptives, and gonadotropin-releasing hormone analogues, are commonly used to control pain symptoms and abnormal uterine bleeding in adenomyosis 2.
- Non-Hormonal Treatments: Non-hormonal treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are also used to manage pain symptoms in adenomyosis 2, 3.
- Levonorgestrel-Releasing Intrauterine System: The levonorgestrel-releasing intrauterine system has been shown to be effective in resolving abnormal uterine bleeding and reducing uterine volume in adenomyosis 2, 4.
- Dienogest: Dienogest, a progestin, has been found to be effective in reducing dysmenorrhea in adenomyosis, with a significant reduction in pain symptoms compared to other medical treatments 5.
- GnRH Agonists: GnRH agonists have been found to be effective in reducing uterine volume in adenomyosis, and may be used before fertility treatments to improve the chances of pregnancy in infertile women with adenomyosis 2, 5.
Treatment Goals
The goal of medical management in adenomyosis is to alleviate symptoms and improve quality of life. Treatment options should be tailored to the individual patient's symptoms and needs.
- Symptom Management: Medical treatments aim to manage symptoms such as heavy menstrual bleeding, pain, and infertility 6, 4.
- Fertility Preservation: For women who wish to preserve their fertility, medical treatments are preferred over surgical options 6, 3.
- Quality of Life: The ultimate goal of medical management in adenomyosis is to improve the patient's quality of life by reducing symptoms and improving overall well-being 2, 6.