Recurrence of uterine adenomyosis after administration of gonadotropin-releasing hormone agonist and the efficacy of dienogest

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

doi:10.1080/09513590.2019.1683818

Cited by 22 publications

(22 citation statements)

References 15 publications

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“…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. All the mentioned studies supported our results and proved the beneficial role of dienogest in reducing pain from adenomyosis.…”

Section: Discussionmentioning

confidence: 99%

“…9 Dienogest can improve endometriosis and adenomyosis-associated pain by causing hypoestrogenemia, which causes atrophy of these ectopic lesions. 10,11 Combined oral contraceptives are also used in the management of adenomyosis by decreasing menstruation and producing a pseudogestational state, which causes decidualization followed by atrophy of the endometrium. 12 Patients with adenomyosis may benefit from the resulting amenorrhea, which may give some relief from related symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Dienogest is a synthetic oral progestin that has a high affinity to progesterone receptors 9 . Dienogest can improve endometriosis and adenomyosis‐associated pain by causing hypoestrogenemia, which causes atrophy of these ectopic lesions 10,11 …”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…GnRH agonists were therefore proposed to both tackle adenomyosis-related hyperestrogenism and decrease proliferative activity in ectopic lesions [ 75 ]. However, although GnRH agonists have long been recognized for their efficiency in reducing uterine volume and providing symptom relief, their use remains limited and short term due to their adverse side effects and, importantly, rapid disease recurrence has been observed upon treatment cessation [ 13 , 76 , 77 , 78 ]. According to Vannuccini and Petraglia [ 13 , 72 ] and Cope et al [ 68 ], use of GnRH agonists for the management of adenomyosis-related pain and bleeding should only be considered for short-term administration because of their menopausal effects, initial flare-up effect, and slow reversibility.…”

Section: Medical Treatment Of Adenomyosismentioning

confidence: 99%

Uterine Adenomyosis: From Disease Pathogenesis to a New Medical Approach Using GnRH Antagonists

Donnez

Stratopoulou

Dolmans

2021

IJERPH

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Uterine adenomyosis is a common chronic disorder frequently encountered in reproductive-age women, causing heavy menstrual bleeding, intense pelvic pain, and infertility. Despite its high prevalence, its etiopathogenesis is not yet fully understood, so there are currently no specific drugs to treat the disease. A number of dysregulated mechanisms are believed to contribute to adenomyosis development and symptoms, including sex steroid signaling, endometrial proliferation and invasiveness, and aberrant immune response. Abnormal sex steroid signaling, particularly hyperestrogenism and subsequent progesterone resistance, are known to play a pivotal role in its pathogenesis, which is why various antiestrogenic agents have been used to manage adenomyosis-related symptoms. Among them, gonadotropin-releasing hormone (GnRH) antagonists are swiftly gaining ground, with recent studies reporting efficient lesion regression and symptom alleviation. The aim of the present review is to compile available information on the pathogenesis of adenomyosis, explore the etiology and mechanisms of hyperestrogenism, and discuss the potential of antiestrogenic therapies for treating the disease and improving patient quality of life.

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“…However, the effect of dienogest on such lesions has scarcely been investigated. In one study, dienogest reduced, to some extent, adenomyotic lesions after 53 weeks of administration [25], while in another it failed to completely block adenomyosis re-growth after suspension of a GnRHanalogue [26]. In young women, combined hormonal contraceptives can ameliorate menstrual pain and reduce menstrual loss, but their efficacy in adenomyosis has not been proven [27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Dienogest-based hormonal contraception induced changes in the ultrasound presentation of the uterus and menstrual pain

2021

Clinical and Experimental Obstetrics & Gynecology

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In young women, combined hormonal contraceptives can ameliorate menstrual pain and reduce menstrual loss, but their efficacy in adenomyosis has not been proven. The aim of this study was to investigate whether ultrasound features of adenomyosis are modified by a combined hormonal contraceptive containing dienogest. Methods: Fifty-eight out of 173 premenopausal women consecutively attending our university hospital outpatient service for contraception were enrolled in this observational study. Women with menstrual pain or heavy menstrual bleeding underwent ultrasonography. An expert sonographer diagnosed or excluded adenomyosis and fibroids via morphological uterus sonographic assessment (MUSA). The intensity of menstrual pain was quantified by each patient on a visual analogue scale (VAS). A total of 38 women with and 20 without ultrasound features of adenomyosis received dienogest-based hormonal contraceptive and had a follow-up ultrasound after 6 months of treatment. Results: During treatment, uterine volume decreased by -13.1 ± 22.1% (p = 0.001) in women with adenomyosis features, while it tended to increase in controls. Hypoechoic striation of myometrium present in 95% of cases and myometrial cysts in 5% of cases, respectively, at baseline, had completely disappeared by 6 months. Asymmetry of uterine walls decreased, with the anterior/posterior wall ratio declining from 2.8 ± 0.8. to 1.9 ± 0.7 (p = 0.0001). Heterogeneous myometrial texture, globous uterine morphology, and junctional zone alteration remained unchanged. In women with baseline adenomyosis, VAS score for menstrual pain decreased by -4.0 ± 3.6 (p = 0.0001). During treatment, a VAS score for menstrual pain close to 0 was found in all women without adenomyosis. Days of menstrual flow decreased in women with (p = 0.0001) and without (p = 0.003) adenomyosis. Conclusions: Dienogest-based hormonal contraceptives improve the sonographic features of adenomyosis and improve symptoms. Prospective data are needed to confirm these findings.

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Recurrence of uterine adenomyosis after administration of gonadotropin-releasing hormone agonist and the efficacy of dienogest

Cited by 22 publications

References 15 publications

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

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

Uterine Adenomyosis: From Disease Pathogenesis to a New Medical Approach Using GnRH Antagonists

Dienogest-based hormonal contraception induced changes in the ultrasound presentation of the uterus and menstrual pain

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