Combination of microwave endometrial ablation and postoperative dienogest administration is effective for treating symptomatic adenomyosis

Ota, Kuniaki; Takahashi, Toshifumi; Shiraishi, Shuichi; Mizunuma, Hideki

doi:10.1111/jog.13720

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…The feature of the current study is that adenomyomectomy was performed for patients with dienogest-resistant adenomyosis, and postoperative dienogest was significantly effective. Previously, we reported that taking dienogest after microwave endometrial ablation to shrink the adenomyotic lesion was efficient in a patient with dysmenorrhea refractory to dienogest [25], and most patients had a similar clinical course in the current series. It may be supposed that the precise reduction of adenomyotic lesions by laparoscopic adenomyomectomy under ultrasonic elastography guidance may have led to the drug effect of dienogest.…”

Section: Discussionsupporting

confidence: 64%

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

Ota

Takahashi

et al. 2022

JCM

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Background: This study aimed to examine the clinical characteristics of 11 patients undergoing laparoscopic adenomyomectomy guided by intraoperative ultrasound elastography and this technique’s feasibility. Patients and Methods: Eleven patients undergoing laparoscopic adenomyomectomy using ultrasound elastography for adenomyosis at Kawasaki Medical “School” Hospital in Okayama, Japan between March 2020 and February 2021 were enrolled. Operative outcomes included operative time, operative bleeding, resected weight, operation complications, percent change in hemoglobin (Hb) values, and uterine volume pre- and postoperatively. Dysmenorrhea improvement was evaluated by changes in visual analog scale (VAS) scores pre- and 6- and 12-months postoperatively. Results: The median operative time and bleeding volume was 125 min (range, 88–188 min) and 150 mL (10–450 mL), respectively. The median resected weight was 5.0 g (1.5–180 g). No intraoperative or postoperative blood transfusions or perioperative complications were observed. The median changes in uterine volume, Hb value, and VAS score were −49% (−65 to −28%), −3% (−11 to 35%), and −80% (−100 to −50%), respectively. The median follow-up period post-surgery was 14 months (7–30 months). Adenomyosis recurrence was not observed in the patients during the follow-up period. Conclusions: Laparoscopic adenomyomectomy using ultrasound elastography guidance is minimally invasive and resects as many adenomyotic lesions as possible.

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Section: Discussionsupporting

confidence: 64%

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

Ota

Takahashi

et al. 2022

JCM

Self Cite

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“…Because of unclear boundaries and irregular shapes of adenomyosis lesions, and unablated nidus tissue around the solidified necrotic tissue after microwave ablation, all these can result in symptoms repeatedly. In most of the studies included herein, the follow-up time lasted 12 months, and no obvious cases of symptom recurrence were reported (28). The short-term efficacy was satisfactory, which may be related to the high ablation rate with microwave ablation.…”

Section: Discussionmentioning

confidence: 89%

Ultrasound-guided percutaneous microwave ablation of adenomyosis: a narrative review

Zhang¹,

Wang²,

Di³

et al. 2021

Ann Palliat Med

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“…27 Neriishi et al 28 observed that the mean VAS score for dysmenorrhea was significantly decreased with longterm use (>80 months) of dienogest in women with adenomyosis. 28 Ota et al 29 concluded that the VAS score showed a significant decrease in women with adenomyosis from before microwave endometrial ablation and after microwave endometrial ablation when dienogest was added postoperatively. Lastly, Matsushima et al 10 proved that adding dienogest for 6 months following 6 months of gonadotropin-releasing hormone agonist administration improved adenomyosis-associated symptoms.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dienogest versus combined oral contraceptive pills in the treatment of women with adenomyosis: A randomized clinical trial

Hassanin

Youssef

Yousef

et al. 2021

Intl J Gynecology & Obste

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Objective To compare the efficacy and safety of dienogest with combined oral contraceptives (COCs) for treating adenomyosis‐associated symptoms. Methods This was a randomized clinical trial including women with symptomatic adenomyosis conducted from March 1, 2019 to August 1, 2020 at Assiut Woman's Health Hospital, Egypt. Participants were randomly assigned to the dienogest group or COCs group. The primary outcome was the level of adenomyosis‐associated pain from before to 6 months after treatment measured by a visual analog scale (VAS). Changes in the uterine bleeding pattern, uterine volume, and uterine artery blood flow were also reported. Results The VAS score of pain was significantly decreased in both groups; however, the decreased rate was more pronounced in the dienogest group (3.21 ± 1.18) in comparison with the COCs group (4.92 ± 1.22). Bleeding pattern was improved greatly; uterine volume and uterine artery blood flow decreased significantly in the dienogest group. However, women in the dienogest group reported a higher rate of side effects. Conclusion Dienogest and COCs are effective in treating adenomyosis‐associated symptoms after 6 months of use but dienogest is more effective. The decrease in uterine volume and uterine artery blood flow may be the cause of the treatment effect. Dienogest carries a higher risk of side effects. Clinical trial.gov: NCT03890042.

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Combination of microwave endometrial ablation and postoperative dienogest administration is effective for treating symptomatic adenomyosis

Abstract: The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea.

Cited by 10 publications

References 19 publications

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

Laparoscopic Adenomyomectomy under Real-Time Intraoperative Ultrasound Elastography Guidance: A Case Series and Feasibility Study

Ultrasound-guided percutaneous microwave ablation of adenomyosis: a narrative review

Comparison of dienogest versus combined oral contraceptive pills in the treatment of women with adenomyosis: A randomized clinical trial

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