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

Abstract

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.

Relationship between magnetic resonance imaging‐based classification of adenomyosis and disease severity

“…These findings may be consistent with clinical data that patients with diffuse adenomyosis suffer from bleeding rather than pain 32 . In addition, Matsubara et al 36 found that type A adenomyosis is related to bleeding and can also strongly cause unexpected bleeding during progestin therapy. On the other hand, type B adenomyosis responds favorably to progestin therapy 36 .…”

“…In addition, Matsubara et al 36 found that type A adenomyosis is related to bleeding and can also strongly cause unexpected bleeding during progestin therapy. On the other hand, type B adenomyosis responds favorably to progestin therapy 36 . Women with type A adenomyosis have less improvement in quality of life after progestin therapy than those with type B adenomyosis, suggesting that there is a difference in the efficacy and safety of progestin therapy between type A and type B adenomyosis.…”

“…Women with type A adenomyosis have less improvement in quality of life after progestin therapy than those with type B adenomyosis, suggesting that there is a difference in the efficacy and safety of progestin therapy between type A and type B adenomyosis. Therefore, both diffuse adenomyosis and type A adenomyosis may be associated with severe menstrual bleeding, suggesting that diffuse adenomyosis with frequent abnormal bleeding may have evolved from type A adenomyosis 36 . Subtype classification of adenomyosis using MRI might be useful for monitoring and predicting the therapeutic efficacy on uterine bleeding 6 …”

“…Since 1972, a number of researchers have attempted to standardize MRI findings in adenomyosis and classify this disease depending on imaging features 4,6,12,24,41–45 . A simplified classification has been proposed to grade the severity or extension of adenomyosis 6,16,20,31–34,36,40 . However, no one has established any validated and universally accepted imaging criteria.…”

A case of hemorrhagic shock occurred during dienogest therapy for uterine adenomyosis

“…It has been well described that dienogest therapy frequently results in irregular bleeding, 3,4 and the bleeding becomes more severe, especially in cases with uterine adenomyosis. 3,5,6 This is the first case report of massive bleeding associated with dienogest therapy that caused a hemorrhagic shock requiring an emergency hysterectomy. In this case, the patient had adenomyosis.…”