Numerous complementary treatments have been used to alleviate the symptoms of endometriosis, but only acupuncture has demonstrated a significant improvement in outcomes. Nevertheless, other approaches demonstrated positive trends toward improving symptoms; this should encourage investigators to design controlled studies to support their applicability.
Objective To assess the efficacy of non-surgical treatment for adenomyosis.
Data Sources A search was performed by two authors in the Pubmed, Scopus, and Scielo databases and in the grey literature from inception to March 2018, with no language restriction.
Selection of Studies We have included prospective randomized studies for treating symptomatic women with adenomyosis (abnormal uterine bleeding and/or pelvic pain) diagnosed by ultrasound or magnetic resonance imaging.
Data Collection Studies were primarily selected by title and abstract. The articles that were eligible for inclusion were evaluated in their entirety, and their data was extracted for further processing and analysis.
Data Synthesis From 567 retrieved records only 5 remained for analysis. The intervention groups were: levonorgestrel intrauterine system (LNG-IUS)(n = 2), dienogest (n = 2), and letrozole (n = 1). Levonorgestrel intrauterine system was effective to control bleeding when compared to hysterectomy or combined oral contraceptives (COCs). One study assessed chronic pelvic pain and reported that LNG-IUS was superior to COC to reduce symptoms. Regarding dienogest, it was efficient to reduce pelvic pain when compared to placebo or goserelin, but less effective to control bleeding than gonadotropin-releasing hormone (GnRH) analog. Letrozole was as efficient as GnRH analog to relieve dysmenorrhea and dyspareunia, but not for chronic pelvic pain. Reduction of uterine volume was seen with aromatase inhibitors, GnRH analog, and LGN-IUD.
Conclusion Levonorgestrel intrauterine system and dienogest have significantly improved the control of bleeding and pelvic pain, respectively, in women with adenomyosis. However, there is insufficient data from the retrieved studies to endorse each medication for this disease. Further randomized control tests (RCTs) are needed to address pharmacological treatment of adenomyosis.
Aims: Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). Methods: This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests).Results: Women with DIE presented more CPP (30% vs 5%; P < .001), dysuria (12.5% vs 3.75%; P = .043) and dyschezia (47.5% vs 2.5%; P < .001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P = .02), weaker PFM contraction (36.35% vs 2.5%; P < .001), and incomplete PFM relaxation (45% vs 13.75%; P < .001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P < .001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM;
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