Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Hong, Yang; Wang, Shengtan; Fu, Xin; Lan, Ruihong; Gong, Huiyu

doi:10.1111/jog.15031

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Our search identified other studies that did not include information about pretreatment menstrual patterns, or the presenting symptoms of women with adenomyosis [51], did not detail how adenomyosis was diagnosed, or include detail for menstrual history [52], or had a high percentage of patients with concomitant fibroids [53].…”

Section: Ishizawa Et Al (2023) [53]mentioning

confidence: 99%

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence

Habiba,

Guo,

Benagiano

2024

Biomolecules

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Background: Thomas Cullen described bleeding abnormalities and dysmenorrhea as the “expected” presentations of adenomyomas. Adenomyosis is included within the FIGO classification of structural causes of abnormal uterine bleeding (AUB). Nevertheless, this long-standing association has been questioned by some authors who reported a high incidence of adenomyosis in uteri removed for indications other than AUB or dysmenorrhea. Here, we examine evidence for the link between adenomyosis and AUB. Methods: A comprehensive Medline literature review of all publications to October 2023. Results: Sixty-three articles were identified and included in the review. Despite a large body of studies, the available literature does not provide conclusive evidence of a link between adenomyosis and AUB. This is because of unsuitable study design, or poor characterization of the study population or of the inclusion or exclusion criteria. Additional challenges arise because of the lack of agreed criteria for diagnosing adenomyosis and the often absence of detailed assessment of menstrual blood loss. Adenomyosis often coexists with other conditions that have also been linked to similar symptoms, and many cases of adenomyosis are asymptomatic. Conclusion: Most of the existing literature and studies that addressed treatment outcome of adenomyosis started from the premise that a link between the condition and AUB had been proven. Yet, published information shows that aspects such a relationship is still uncertain. Further research is needed to address the relation between AUB and adenomyosis burden (or subtypes), distribution, and concomitant pathology.

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Section: Ishizawa Et Al (2023) [53]mentioning

confidence: 99%

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence

Habiba,

Guo,

Benagiano

2024

Biomolecules

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“…Relevant studies have pointed out [17] that patients with adenomyosis have significant immunoregulatory dysfunction, which leads to ineffective removal of the myometrial endometrium, increased levels of inflammatory mediators and disease aggravation. Serum IL-8 stimulates neutrophil chemotaxis and stromal cell proliferation, aggravates immune responses, and induces the body to produce new blood vessels, while it accelerates ectopic endometrial implantation under the combined action of serum TNF-α and IL-8 [18,19]. Some scholars have found that TNF-α levels are higher in adenomyosis patients than in healthy women, and the reason may be due to increased monocyte activity in the peripheral blood [20].…”

Section: Adenomyosis Invades the Myometrium But Does Not Extendmentioning

confidence: 99%

Effects of Shixiao Huoxue Decoction on pain, tumor necrosis factor-α, and interleukin-8 in patients with adenomyosis

2024

Am J Transl Res

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Objective: To explore the effect of Shixiao Huoxue Decoction on pain and tumor necrosis factor (TNF)-α and interleukin (IL)-8 levels in patients with adenomyosis. Methods: A total of 65 patients with adenomyosis admitted to South District of Guang'anmen Hospital from January 2020 to December 2021 were divided into two groups according to the treatment methods. The control group was treated with pregnatrienone, and the study group was treated with additional Shixiaohuoxue decoction. The incidence of complications, treatment efficacy, levels of inflammatory factors, Traditional Chinese Medicine symptom score, dysmenorrhea score, menstrual volume score, dysmenorrhea symptom score, changes in uterine volume, level of insulin-like growth factor 1 (IGF-1), and changes in the level of carbohydrate antigen (CA125) were observed before and after treatment in both two groups. Univariate Logistic analysis showed that uterine volume, IGF-1, CA125, serum IL-8 and TNF-α were correlated with the short-term efficacy of Meixiaohuoxue Decoction in the treatment of uterine adenomyosis (P<0.05). Results: The levels of IL-8 and TNF-α in the study group were significantly lower than those in the control group after treatment (P<0.05). The scores of dyspareunia and non-menstrual pelvic pain in the study group were significantly lower than those in the control group (P<0.05). The overall response rate in the study group (93.75%) was significantly higher than that in the control group (66.66%) (P<0.05). The scores of Traditional Chinese Medicine symptoms, dysmenorrhea, menstrual volume, and dysmenorrhea symptoms in the study group were significantly lower than those in the control group after treatment (P<0.05). The IGF-1 and CA125 levels in the study group were significantly lower than those in the control group after treatment (P<0.05). However, no significant difference in uterine volume was found between the two groups after treatment (P>0.05). Conclusion: Xiaoxiao Huoxue Decoction demonstrated a better treatment efficacy in patients with adenomyosis through improving dysmenorrhea and Traditional Chinese Medicine symptoms, as well as reducing the levels of body inflammatory factors, non-menstrual pelvic pain, and dyspareunia, thus contributing to early recovery of patients. Therefore, Xiaoxiao Huoxue Decoction is worthy of promotion in clinical treatment of adenomyosis.

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“…Third, comparing the efficacy and side effects of DNG versus LNG-IUS [17,26,27], the latter was found to be an effective first-line treatment for reducing heavy menstrual bleeding and pain in patients with or without adenomyosis [2,7,9,11,20,28]. Additionally, several clinical studies revealed that LNG-IUS allowed long-term improvements in the quality of life of women with adenomyosis [2,9,20].…”

Section: Comparing the Efficacy And Adverse Events Of Dng And Differe...mentioning

confidence: 99%

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Kobayashi

2023

Gynecol Obstet Invest

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Background Adenomyosis is an estrogen-dependent gynecologic condition that can cause pain symptoms, heavy menstrual bleeding, and infertility. Several treatments, including hormonal therapy can improve patients' quality of life through alleviating symptoms. Dienogest (DNG), a 19-norsteroid derivative oral progestin, is a promising treatment option for adenomyosis. Objectives This review aims to summarize the clinical outcomes (efficacy and adverse events) of DNG treatment for symptomatic adenomyosis compared with other hormonal treatments, discuss the mechanism underlying adverse events, and identify future challenges. Methods A literature search was performed across the PubMed and Google Scholar databases up to March 2022 to identify relevant literature. Outcome Out of 449 identified records, 37 articles met the inclusion and exclusion criteria. Five prospective and three retrospective studies showed that DNG and other hormonal agents had similar efficacy for pain relief; however, the most common adverse event of DNG was abnormal uterine bleeding. Specific demographic and clinicopathologic characteristics have been identified as associated with an increased risk of bleeding. Several factors, such as diffuse or type I adenomyosis, advanced reproductive age, severe dysmenorrhea, elevated serum CA125 levels, or low hemoglobin levels, may be implicated in bleeding risk; however, there is no accurate and reliable parameter. Future challenges with the widespread use of DNG include validation of candidate risk indicators and approaches to treat diffuse or type I adenomyosis. Conclusions and Outlook DNG represents an important therapeutic option to be included in the treatment algorithm for adenomyosis owing to sufficient pain relief, despite high rates of bleeding-related adverse events. Clinicians should consider an individual’s potential risk factors for bleeding until high-quality evidence is available.

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Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Cited by 5 publications

References 13 publications

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence

Effects of Shixiao Huoxue Decoction on pain, tumor necrosis factor-α, and interleukin-8 in patients with adenomyosis

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

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