Efficacy of hormonal therapies for decreasing uterine volume in patients with adenomyosis

Matsushima, Takashi; Akira, Shigeo; Fukami, Tatsuki; Yoneyama, Kihei; Takeshita, Toshiyuki

doi:10.4103/gmit.gmit_35_18

Cited by 34 publications

(32 citation statements)

References 19 publications

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“…The uterus of patients with adenomyosis is usually larger than the normal uterus. Our results are consistent with previous studies that have shown that DNG has no obvious effect on the reduction of the uterus size [18,19]. In this study, the uterus enlarged in 31 of 56 patients in the DNG group and 1 of 62 patients in the GS group.…”

Section: Discussionsupporting

confidence: 93%

A Cohort Study of the Efficacy of the Dienogest and the Gonadotropin-Releasing Hormone Agonist in Women with Adenomyosis

MM¹,

Yuan²,

Jiao³

et al. 2021

austiniobstetgynecol

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Purpose: To study the efficacy and safety of the dienogest and the Gonadotropin-Releasing Hormone agonist (GnRH-a) in symptomatic females with uterine adenomyosis. Methods: A total of 127 patients with adenomyosis with a chief complaint of dysmenorrhea were recruited. The first group received 2mg of Dienogest (DNG) daily, whereas the second group received Goserelin Acetate (GS) (3.6mg/4 weeks) for 12 weeks. Outpatient follow-up was undertaken after 12 weeks. Results: Among 127 women, 56/63 (87.5%) patients completed the treatment in the DNG group, whereas 62/64 (96.9%) patients completed the treatment in the GS group. A significant decrease in dysmenorrhea symptoms as measured by the Visual Analog Scale (VAS) and Carcinoma Antigen125 (CA125) after 12 weeks of treatment was observed in both groups (P<0.001). The hemoglobin of anemic patients did not significantly improve after 12 weeks of treatment (P=0.21) and the uterine volume slightly increased without statistical significance (P=0.10) in the DNG group. Simultaneously, the hemoglobin of anemic patients significantly improved (P<0.001) and the uterine volume significantly decreased (P<0.001) in the GS group. Conclusions: Dienogest effectively alleviates the symptoms of dysmenorrhea in patients with adenomyosis, but it cannot improve the anemia or reduce the size of the uterus. GnRH-a is more effective in improving anemia and reducing the uterine volume in patients with adenomyosis.

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Section: Discussionsupporting

confidence: 93%

A Cohort Study of the Efficacy of the Dienogest and the Gonadotropin-Releasing Hormone Agonist in Women with Adenomyosis

MM¹,

Yuan²,

Jiao³

et al. 2021

austiniobstetgynecol

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“…This study showed a definite 50% reduction in fibroid size is preceded by a 35% reduction after four weeks in 81% of cases [ 27 ]. In a study by Matsushima et al [ 28 ] it showed that after hormonal treatment of 16 weeks with GnRH agonist, low-dose estrogen and progestin combination (LEP) and Dienogest in patients with adenomyosis, there was a significant reduction in the GnRH agonist group but there was a non-statistically significant increase in uterine volume in both the LEP and Dienogest groups; where these therapies were ineffective in reducing uterine volume in 53.3% and 44.5% of patients respectively. With greatest increase in size of 2-folds in the LEP and 2.1-fold increase in the Dienogest group, possibly hypothesized to be due to there being four subtypes of adenomyosis when assessed by MRI and each have shown to have different pathogenesis [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

et al. 2021

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Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

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“…However, DNG has also been used for treatment of adenomyosis-related symptoms 26,30 , despite a lack of formal knowledge of its side-effects and efficacy in this context. Indeed, efficacy of DNG in treating adenomyosis reportedly varies by individual, in contrast to treatment with GnRHa 34,35 . Although DNG potentially has the advantages of relatively long-term efficacy and oral administration, there is currently no proper therapeutic management protocol for its use in treating adenomyosis 16 .…”

Section: Discussionmentioning

confidence: 99%

Uterine adenomyosis is an oligoclonal disorder associated with KRAS mutations

Inoue

Hirota

Ueno³

et al. 2019

Nat Commun

111

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Uterine adenomyosis is a benign disorder that often co-occurs with endometriosis and/or leiomyoma, and impairs quality of life. The genomic features of adenomyosis are unknown. Here we apply next-generation sequencing to adenomyosis (70 individuals and 192 multi-regional samples), as well as co-occurring leiomyoma and endometriosis, and find recurring KRAS mutations in 26/70 (37.1%) of adenomyosis cases. Multi-regional sequencing reveals oligoclonality in adenomyosis, with some mutations also detected in normal endometrium and/or co-occurring endometriosis. KRAS mutations are more frequent in cases of adenomyosis with co-occurring endometriosis, low progesterone receptor (PR) expression, or progestin (dienogest; DNG) pretreatment. DNG’s anti-proliferative effect is diminished via epigenetic silencing of PR in immortalized cells with mutant KRAS. Our genomic analyses suggest that adenomyotic lesions frequently contain KRAS mutations that may reduce DNG efficacy, and that adenomyosis and endometriosis may share molecular etiology, explaining their co-occurrence. These findings could lead to genetically guided therapy and/or relapse risk assessment after uterine-sparing surgery.

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Efficacy of hormonal therapies for decreasing uterine volume in patients with adenomyosis

Cited by 34 publications

References 19 publications

A Cohort Study of the Efficacy of the Dienogest and the Gonadotropin-Releasing Hormone Agonist in Women with Adenomyosis

A Cohort Study of the Efficacy of the Dienogest and the Gonadotropin-Releasing Hormone Agonist in Women with Adenomyosis

Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

Uterine adenomyosis is an oligoclonal disorder associated with KRAS mutations

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