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

Abstract

This study elucidated the degree of adenomyosis recurrence following gonadotropin-releasing hormone agonist (GnRHa) discontinuation and dienogest efficiency for recurrent adenomyosis. This retrospective cohort study included 30 patients, divided into a group of patients whose progress was observed without providing additional therapy following GnRHa administration for six months (Group G) and a group of patients administered dienogest for six months following six months of GnRHa administration (Group D). Menorrhagia, dysmenorrhea, chronic pelvic pain, abdominal fullness, and uterine volume were recorded prior to treatment, six months after the start of therapy (6 M), and 12 months after the start of therapy (12 M). In Group G (n = 15), although all subjective symptoms disappeared at 6 M, nearly all symptoms recurred at 12 M. Uterine volume significantly decreased from 341.0 cm³ to 156.0 cm³ at 6 M (p = .001) and significantly increased again to 282.3 cm³ at 12 M (p = .003). In Group D (n = 15), all subjective symptoms disappeared at 6 M, and only abdominal fullness returned in a significant number of patients (5 of 5; p = .021) at 12 M. Uterine volume decreased significantly at 6 M (p = .003) and significantly increased again from 162.5 cm³ to 205.6 cm³ at 12 M (p = .006). Subjective symptoms, except for abdominal fullness, did not recur when dienogest was administered after GnRHa.

摘要

本研究阐明了促性腺激素释放激素激动剂（GnRHa）停药后子宫腺肌症复发的程度及地诺孕素治疗复发性子宫腺肌症的疗效。这项回顾性队列研究纳入30名患者, 分为两组, 一组在GnRHa治疗6个月后观察病情进展, 没有额外治疗（G组）, 另一组在GnRHa治疗6个月后服用地诺孕素6个月（D组）。记录治疗前、治疗6个月后（6M）和治疗12个月后（12M）的月经过多、痛经、慢性盆腔疼痛、腹胀和子宫体积。在G组（n=15）, 虽然所有主观症状在6M时消失, 但在12M时几乎所有症状均复发, 子宫体积在6M时由341.0 cm³降至156.0 cm³ （P=0.001）, 在12M时再次显著增加至282.3 cm³（P=0.003）。D组（n=15）在6M时所有主观症状消失, 在12M时有相当数量的患者（5/5；P=0.021）仅复发了腹胀, 子宫体积在6M时显著减小（P=0.003）, 在12M时再次显著增加（P=0.006）, 从162.5 cm³增加到205.6cm³（P=0.006）。除腹胀外的主观症状在GnRHa给药后服用地诺孕素时没有复发。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Adenomyosis
• GnRH agonist
• dienogest
• maintenance therapy
• pelvic pain

Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

Disclosure statement

The authors report no conflicts of interest.