Long‐term dienogest administration in patients with symptomatic adenomyosis

Neriishi, Kazuaki; Hirata, Tetsuya; Fukuda, Seisuke; Izumi, Gentaro; Nakazawa, Atsuko; Yamamoto, Nobuto; Harada, Miyuki; Hirota, Yasushi; Koga, Kaori; Wada‐Hiraike, Osamu; Fujii, Tomoyuki; Osuga, Yutaka

doi:10.1111/jog.13674

Cited by 51 publications

(58 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding provides a novel mechanistic approach that continuous DNG therapy increases the risk of serious bleeding events in patients with subtype I adenomyosis. This finding was supported by recent data suggesting that DNG remains as an alternative option in the treatment of subtype II adenomyosis 11 .…”

Section: Discussionsupporting

confidence: 78%

“…Recognized approaches for protecting the QOL of patients are surgery for removing adenomyosis mass and systemic hormonal treatments for terminating dysmenorrhea 4 . If necessary, even surgery such as adenomyomectomy that emphasizes fertility preservation can be applied, but its implementation is lacking in many resource-limited settings 11 . Currently, DNG is commonly used in progestin therapy in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…9 . Some data on adverse effects of DNG, especially on bleeding pattern, have been reported 10,11 . Younger age, anemia before treatment, changes of serum estradiol levels after DNG treatment, and the structural type of adenomyosis appear to be at the risk of uterine bleeding.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis

Matsubara

Kawaguchi

Akinishi

et al. 2019

Sci Rep

View full text Add to dashboard Cite

We aimed to retrospectively analyze the risk factors of a continuous dienogest (DNG) therapy for serious unpredictable bleeding in patients with symptomatic adenomyosis. This is a retrospective study based on data extracted from medical records of 84 women treated with 2 mg of DNG orally each day between 2008 and 2017. 47 subjects were excluded from the original analyses due to an inadequate subcategorization into subtype I and subtype II and a lack of hemoglobin levels. The influence of various independent variables on serious unpredictable bleeding was assessed. Of the 37 eligible patients who received the continuous DNG therapy, 14 patients experienced serious unpredictable bleeding. Univariate analysis revealed that the serious bleeding group had subtype I adenomyosis (P = 0.027). There was no correlation between age, parity, minimum hemoglobin level before treatment, previous endometrial curettage, and duration of DNG administration, or uterine or adenomyosis size and the serious bleeding. A DNG-related serious unpredictable bleeding is associated with the structural type of adenomyosis (subtype I) in patients with symptomatic adenomyosis.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis

Matsubara

Kawaguchi

Akinishi

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Although serum CA125 is considered as a high-risk factor for recurrence of adenomyosis and an indicator of therapeutic efficacy in adenomyosis,10,26–28 yet, our results did not find any significant differences with respect to the recurrence of adenomyosis between patients with CA 125 levels >200 kU/L and CA 125 levels ≤200 kU/L. Moreover, although the recurrence rates of adenomyosis were all higher in patients with adenomyosis infiltrating whole uterine wall, younger age, and large uterine size when compared with that in patients with adenomyosis infiltrating posterior or anterior uterine wall, old age, and small uterine size, yet, the differences did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

Zhu¹,

Chen²,

Che³

et al. 2019

JPR

View full text Add to dashboard Cite

Purpose Studies have shown that adenomyomectomy can effectively treat women with adenomyosis in a short period of time. However, the long-term efficacy of adenomyomectomy has rarely been reported. The objective of this study was to determine whether laparotomy is superior to laparoscopic surgery in the long-term efficacy of double-flap method adenomyomectomy for severe diffuse adenomyosis. Methods Between March 2011 and September 2018, a total of 148 patients with severe uterine diffuse adenomyosis who underwent laparoscopic (group A, n=72) and laparotomic (group B, n=76) double-flap adenomyomectomy were recruited. Adenomyomectomy efficacy and adenomyosis recurrence after surgery between groups A and B were comparatively analyzed. Results The effective rate at 6-year follow up after surgery was higher in group B (75.0%) than that in group A (62.1%), while the 6-year cumulative recurrence rate was higher in group A (27.8%) than that in group B (17.1%), but the differences did not reach statistical significance between the two groups ( P >0.05). The recurrence rate was lower in patients who were treated with gonadotropin-releasing hormone agonist (GnRHa) plus Mirena or oral contraceptives post-surgically than that in patients who were treated with only GnRHa post-surgically in groups A (51.6% vs 9.8%, P <0.01) and B (33.3% vs 6.5%, P <0.05). Moreover, the recurrence rate of adenomyosis patients with endometriosis was higher than that of adenomyosis patients without endometriosis in group A (55.0% vs 17.3%, P <0.05) and group B (36.0% vs 7.8%, P <0.05). Conclusion The long-term outcomes of laparoscopic and laparotomic double-flap adenomyomectomy can be achieved for severe diffuse uterine adenomyosis, but laparotomy seems to have advantages over laparoscopy. Postoperative drug use may be beneficial to reduce the recurrence of adenomyosis, especially for adenomyosis with endometriosis.

show abstract

“…Therefore, all patients in this analysis had a certain level of endometriosis severity. Additionally, we did not analyze the treatment period of dienogest, because DNGT was generally used for the long term and was continued until menopause in some cases [20].…”

Section: Methodsmentioning

confidence: 99%

Significant risk factors for malignant transformation of ovarian endometrioma during dienogest treatment: a case report and retrospective study

et al. 2019

View full text Add to dashboard Cite

BackgroundTo determine the prevalence of and risk factors for malignant transformation of ovarian endometrioma during dienogest therapy, which is very rare, we examined multiple cases of malignant transformation of ovarian endometrioma during dienogest therapy and performed a multivariate analysis of the records in our hospital.MethodsThe medical records of 174 patients who underwent DNGT for the treatment of OMA from June 1, 2011, to May 31, 2018, were reviewed retrospectively with the approval of the Human Ethical Committee of the University of Teikyo Hospital. And we provided one representative case of MT with obtaining written informed consent. To assess the effects of six representative factors, including advanced age, parity, surgical history, and endometrial cyst characteristics (including 3 factors), on the possibility of malignant transformation, we performed a multivariate logistic regression analysis.ResultsOf the 174 cases, 4 were diagnosed with malignant transformation, and these cases are reported. In the multivariate analysis, advanced age (P = 0.0064), nullipara (P = 0.0322), and enlargement (P = 0.0079) showed significant differences for malignant transformation occurrence. All 4 malignant transformation cases were among the 19 patients who had all of these 3 factors.ConclusionsFor a more accurate determination of the treatment approach, a larger sample size will be needed to determine the risk factors for malignant transformation during dienogest therapy.

show abstract

Long‐term dienogest administration in patients with symptomatic adenomyosis

Abstract: Our report suggests that dienogest is tolerable for long-term use until menopause and can be an alternative treatment option in some patients, especially those with type 2 adenomyosis, to avoid hysterectomy.

Cited by 51 publications

References 20 publications

Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis

Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis

<p>Comparisons of the efficacy and recurrence of adenomyomectomy for severe uterine diffuse adenomyosis via laparotomy versus laparoscopy: a long-term result in a single institution</p>

Significant risk factors for malignant transformation of ovarian endometrioma during dienogest treatment: a case report and retrospective study

Contact Info

Product

Resources

About