What are the take-home medications for adenomyosis?

Take-Home Medications for Adenomyosis

The levonorgestrel-releasing intrauterine device (LNG-IUD) is the first-line take-home medical therapy for adenomyosis, providing superior symptom control compared to other hormonal options. 1, 2

First-Line Therapy

• The LNG-IUD reduces menstrual blood loss by 71-95% and provides significant improvement in both pain and bleeding symptoms. 3
• This device acts primarily at the endometrial level with minimal systemic hormone absorption, making it suitable for most patients including those with metabolic concerns. 3
• The LNG-IUD offers long-term management with user-independent efficacy after placement. 4
• A recent randomized controlled trial demonstrated that the LNG-IUD provides superior pain and bleeding control compared to combined oral contraceptives in women with adenomyosis. 4

Second-Line Oral Medications

Combined Oral Contraceptives

• Combined oral contraceptives reduce painful and heavy menstrual bleeding, though they are less effective than the LNG-IUD. 4, 1
• These can be used continuously to suppress menstruation and control symptoms. 5

Oral Progestins

• High-dose progestins (such as dienogest, norethindrone acetate) are effective alternatives for adenomyosis treatment. 1
• Cyclic oral progestin reduces bleeding by 87%, often resulting in only light bleeding. 3
• Progestins have antiproliferative and anti-inflammatory effects that help control pain symptoms. 6

GnRH Antagonists

• Oral GnRH antagonists (such as relugolix) are highly effective for heavy menstrual bleeding, even with concomitant adenomyosis. 1, 2, 3
• These medications provide equivalent pain relief to older GnRH agonists but with better tolerability. 1
• Critical caveat: Fertility is suppressed during treatment, and symptoms rapidly recur after cessation. 2
• Add-back therapy must be used with long-term GnRH therapy to prevent bone mineral loss. 1

Danazol

• Danazol is equally effective to GnRH agonists but has more androgenic side effects (acne, hirsutism, weight gain). 1
• This limits its use as a first-line option despite its efficacy. 6

Non-Hormonal Adjunct

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain control, though they do not address the underlying condition or heavy bleeding. 6

Critical Management Principles

Realistic Expectations

• No medical therapy has been proven to eradicate adenomyosis lesions—all treatments provide only temporary symptom relief. 1, 2
• Symptoms recur after discontinuation of hormonal suppression. 2
• There is no evidence that medical treatment affects future fertility in women with adenomyosis. 1

Treatment Duration

• Medical therapies can be used long-term for symptom management, with the LNG-IUD effective for up to 5-7 years. 3
• GnRH agonists and antagonists should be limited in duration due to bone density concerns unless add-back therapy is used. 1

When Medical Therapy Fails

• If take-home medications fail to control symptoms after 3 months of adequate trial, consider interventional options such as uterine artery embolization (94% short-term improvement) or definitive surgical management. 1, 3
• Only 7-18% of patients require hysterectomy for persistent symptoms after attempting conservative measures. 1