The role of progestin subdermal implant in the management of adenomyosis: a systematic review

Abstract

Purpose

The long-acting reversible contraception progestin subdermal implant (ENG implant) may be effective to improve endometriosis-related symptoms. Since adenomyosis is a histopathological form of endometriosis, we aimed to evaluate the effectiveness of ENG implant in adenomyosis management

Materials and methods

Electronic search in Medline, Scopus, Embase databases and Google Scholar using combinations of the following keywords: Progestin; subdermal implant; Implanon; Nexplanon; Adenomyosis; Endometriosis.

Results

Out of 889 articles in the initial database, 5 prospective observational studies were eligible for inclusion in our literature review. Our review involving 152 participants found a significant reduction in pelvic pain and dysmenorrhoea (baseline median VAS score ranged from 10 to 7.62 before implantation vs VAS score ranged from 1.81 to 0.1 after implantation) as well as an increase in the levels of haemoglobin after implantation of the device (from 86 g/L to 129 g/L after implantation). Moreover, the improvement may be sustained throughout the long-term follow-up visits (until 36 months). The most common adverse events were changes in bleeding patterns which were tolerable in most cases.

Conclusion

ENG implant may be a relevant and promising medical option in the management of adenomyosis. Nevertheless, randomised controlled trials and prospective studies with larger cohorts are needed to confirm the potential role of ENG implant in the management of adenomyosis

SHORT CONDENSATION

The etonogestrel-releasing subdermal contraceptive implant may be a relevant medical option in the management of adenomyosis.

摘要

目的

长效可逆孕激素皮下埋植剂(ENG皮下埋植剂)可有效改善子宫内膜异位症相关症状。由于子宫腺肌病是子宫内膜异位症的一种组织病理学形式, 我们的目的是评价ENG皮下埋植剂在子宫腺肌病治疗中的有效性。

材料和方法

检索Medline、Scopus、Embase数据库和Google Scholar, 以下关键词进行组合: 孕激素；皮下埋植剂；依伴侬；依托孕烯植入剂；子宫腺肌病；子宫内膜异位症。

结果

在数据库中初始检索到889篇文章, 有5篇前瞻性观察性研究符合文献纳入标准。对152名参与者的综述发现, 盆腔疼痛和痛经显著减少(植入前中位VAS评分为10到7.62, 植入后中位VAS评分为1.81到0.1), 以及植入后血红蛋白水平上升(从植入前的86g/L上升到129g/L)。此外, 这种改善可能长期持续至整个随访期间(直到36个月)。最常见的不良事件是出血模式的改变, 这在大多数情况下是可以耐受的。

结论

ENG皮下埋植剂可能是治疗子宫腺肌病的一种有前景的医疗选择。然而, 需要随机对照试验和更大队列的前瞻性研究来证实ENG皮下埋植剂在治疗子宫腺肌病中的潜在作用。

Keywords:

• Adenomyosis
• endometriosis
• progestin subdermal implant
• etonogestrel
• pelvic pain
• menstrual bleeding
• nexplanon

Acknowledgements

The authors thank Dea Špiljarić for her advice in medical manuscript editing.

Data availability

Data are available upon reasonable request.

Disclosure statement

G. Chene¹, H. Baffet, and A. Agostini has served as consultants and members of advisory boards for Organon. The other authors (E. Cerruto, E. Nohuz) declare no conflict of interest to disclose.

Figure 1. Prisma flow chart.

Figure 2. Pelvic pain before and after implantation of ENG implants [11,12,15,18].

Figure 3. Haemoglobin levels (g/L) before and after implantation of ENG implants [11,12,18].

Figure 4. Menstrual bleeding pattern (%) after implantation of ENG implants [11,12,15,18].

Figure 5. Uterine volume (cm³) before and after implantation of ENG implants [11,12,18].