Role of medical therapy in the management of uterine adenomyosis

Vannuccini, Silvia; Luisi, Stefano; Tosti, Claudia; Sorbi, Flavia; Petraglia, Felice

doi:10.1016/j.fertnstert.2018.01.013

Cited by 176 publications

(196 citation statements)

References 94 publications

(89 reference statements)

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“…In the present study, we found that mifepristone reduces the secretion of IL-6 and TNF-α from endometrial epithelial and stromal cells in adenomyosis. Similar to MPA and danazol treatment of adenomyosis [32,33], mifepristone treatment inhibited the secretion of IL-6 in endometrial epithelial and stromal cells of adenomyosis in our experiments. Yang et al reported that MPA and danazol have no effect on the suppression of TNF-α by endometrial and stromal cells in adenomyosis [34] while our data showed mifepristone significantly decreased the mRNA and protein expression of TNF-α in both endometrial epithelial and stromal cells of adenomyosis.…”

Section: Discussionsupporting

confidence: 77%

The new application of mifepristone in the relief of adenomyosis-caused dysmenorrhea

Che

Wang

et al. 2020

Int. J. Med. Sci.

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Background: Adenomyosis is a quite common gynecological disorder and above 30% of patients have typical secondary and progressive dysmenorrhea. Current treatments still have many disadvantages and thereby the novel treatment aiming to relieve dysmenorrhea still needs to be further investigated. Mifepristone is a wonderful drug because it is effective, safe and cheap in many diseases including adenomyosis. In this study, we aim to investigate if mifepristone could be used in the treatment of adenomyosis-associated dysmenorrhea. Methods: Human primary endometrial epithelial and stromal cells from adenomyosis patients were isolated and treated with mifepristone. RNA-sequencing was then performed to detect the gene changes of pain-related inflammatory mediators. Meanwhile, the effect of mifepristone on the infiltration and degranulation of mast cells were investigated in adenomyosis lesions. Additionally, the role of mifepristone on the density of nerve fibers was also studied in the ectopic endometrium. At last, to evaluate the therapeutic efficacy of mifepristone on dysmenorrhea of adenomyosis, twenty participants were included and the visual analog scale (VAS) score was assessed and compared before and after treatment with mifepristone. Results: We demonstrated that mifepristone reduced the secretion of IL-6 and TNF-α from endometrial epithelial and stromal cells, restricted the infiltration and degranulation of mast cells in eutopic and ectopic endometrium and decreased the density of nerve fibers by inhibiting the migration capacity of nerve cells in adenomyosis. Meanwhile, we found that mifepristone could significantly relieve dysmenorrhea of adenomyosis. Conclusion: The findings demonstrated that mifepristone could be applied in the treatment of dysmenorrhea for the adenomyosis patients.

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Section: Discussionsupporting

confidence: 77%

The new application of mifepristone in the relief of adenomyosis-caused dysmenorrhea

Che

Wang

et al. 2020

Int. J. Med. Sci.

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“…However, no drug is currently labeled for adenomyosis, and there are no specific guidelines to follow for best management. [ 13 ] Two important observations can be made from this study. First, GnRHa therapy significantly reduced the volume of adenomyosis, while LEP or DNG therapy resulted in neither a significant reduction nor increase in uterine volume.…”

Section: Discussionmentioning

confidence: 75%

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

Matsushima

Akira

Fukami

et al. 2018

Gynecol Minim Invasive Ther

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Study objective:The aim of this study is to evaluate the efficacy of hormonal therapies for inhibiting an increase in uterine volume in patients with adenomyosis.Design:This was retrospective cohort study.Setting:This study was conducted at Nippon Medical School Musashikosugi Hospital.Patients:A total of 28 women diagnosed with adenomyosis using magnetic resonance imaging.Methods:After providing informed consent, patients were treated with gonadotropin-releasing hormone agonist (GnRHa group), a low-dose estrogen and progestin combination (LEP group), or dienogest (DNG group) for ≥16 weeks. Uterine volume was assessed using the formula for an ovoid; uterine volumes before and after 16 weeks of treatment were compared. A <5% increase in uterine volume at 16 weeks was considered to reflect inhibition of uterine volume increase and efficacy of the medication. We compared the efficacy rate among the groups.Results:In the GnRHa group, a significant reduction in uterine volume was noted, from 307.4 ± 230.1 to 177.9 ± 142.1 cm3 (P < 0.001). In the LEP and the DNG groups, there was no significant change (LEP: 226.7 ± 116.6 cm3 pre-treatment and 230.5 ± 128.6 cm3 post-treatment, P = 0.85; DNG: 232.6 ± 117.8 cm3 pre-treatment and 262.1 ± 136.8 cm3 post-treatment, P = 0.37). The number of responders (efficacy rate) in the GnRHa group, LEP group, and DNG group was 25/26 (96.2%), 7/15 (46.7%), and 6/11 (54.5%), respectively. The efficacy rate of GnRHa therapy was significantly higher than that of LEP or DNG therapy (P < 0.001 and P = 0.005, respectively).Conclusion:We conclude that the efficacy of GnRHa in reducing uterine volume should be considered when prescribing hormone therapy for adenomyosis.

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“…5 Adenomyosis symptoms can be disabling and have been treated medically, despite no U.S. Food and Drug Administrationeapproved therapies, 1 and surgically. 7 Better data on efficacy of medical treatment would assist women who prefer not to have hysterectomy. Tools that can track adenomyosis incidence, prevalence, and treatment response will be important as new therapies targeted at the pathogenesis of the disease-sex steroid regulation, inflammation, apoptosis, and neuroangiogenesis manipulation 7,8 are developed.…”

mentioning

confidence: 99%

Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Schulze‐Rath

Grafton

et al. 2020

American Journal of Obstetrics and Gynecology

127

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BACKGROUND: Adenomyosis symptoms are disabling. Populationbased data on incidence and prevalence of adenomyosis are lacking that could guide future evidence-based treatments and clinical management. OBJECTIVE: To evaluate the incidence, 10-year secular trends, and prevalence of adenomyosis diagnoses and to describe symptoms and treatment patterns in a large U.S. cohort. STUDY DESIGN: We performed a retrospective population-based cohort study of women aged 16e60 years in 2006e2015, enrolled in Kaiser Permanente Washington, a mixed-model health insurance and care delivery system. Adenomyosis diagnoses identified by ICD codes from the International Classification of Diseases 9th and 10th editions and potential covariates were extracted from computerized databases. Women with prior hysterectomy, and for incidence estimates women with prior adenomyosis diagnoses, were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression. Rates and trend tests were examined for all women adjusting for age using direct standardization to the 2015 study population, by age groups, and by race/ethnicity. Chart reviews were performed to validate diagnostic accuracy of ICD codes in identifying adenomyosis incidence. Symptoms and treatment patterns at diagnosis and in the following 5 years were assessed. RESULTS: A total of 333,693 women contributed 1,185,855 woman-years (2006e2015) for incidence calculations. Associated symptom-related codes (menorrhagia or abnormal uterine bleeding, dysmenorrhea or pelvic pain, dyspareunia, and infertility) were observed in 90.8%; 18.0% had co-occurrent endometriosis codes and 47.6% had cooccurrent uterine fibroid codes. The overall adenomyosis incidence was 1.03% or 28.9 per 10,000 woman-years, with a high of 30.6 in 2007 and a low of 24.4 in 2014. Overall age-adjusted estimated incidence rates declined during the 10-year study interval (linear trend P < .05). Incidence was highest for women aged 41e45 years (69.1 per 10,000 womanyears in 2008) and was higher for black (highest 44.6 per 10,000 woman-years in 2011) vs white women (highest 27.9 per 10,000 womanyears in 2010). Overall prevalence in 2015 was 0.8% and was highest among women aged 41e45 years (1.5%). Among the 624 potential adenomyosis cases identified by diagnostic codes in 2012e2015 and with sufficient information in the medical record to determine true case status, 490 were confirmed as incident cases, yielding a 78.5% (95% confidence interval, 75.1%, 81.7%) positive predictive value of adenomyosis ICD-9/ICD-10 codes for identifying an incident adenomyosis case. Health care burden was substantial: 82.0% of women had hysterectomies, nearly 70% had imaging studies suggestive of adenomyosis, and 37.6% used chronic pain medications. CONCLUSION: Adenomyosis burden to the individual and the health care system is high. Incidence rates are disproportionately high among black women. These findings are of concern, as currently available longterm medical therapies remain limited beyond hysterec...

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Role of medical therapy in the management of uterine adenomyosis

Cited by 176 publications

References 94 publications

The new application of mifepristone in the relief of adenomyosis-caused dysmenorrhea

The new application of mifepristone in the relief of adenomyosis-caused dysmenorrhea

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

Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

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