A clinical observational study on the efficacy of subcutaneous etonogestrel implants for adenomyosis in 20 patients

Abstract

Objective: To evaluate the efficacy of subcutaneous etonogestrel implants for adenomyosis.

Methods: We conducted a clinical observational study of 20 patients suffering from adenomyosis treated with subcutaneous etonogestrel implants from August 2015 to July 2017 and followed up for 36 months. We evaluated the efficacy of subcutaneous etonogestrel implants primarily based on the following indicators: the pictorial blood loss assessment chart (PBAC) for menstrual blood volume, changes in bleeding patterns, the visual analog scale (VAS) pain score for dysmenorrhea, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin levels and side effects.

Results: During the 3 years of follow-up, subcutaneous etonogestrel implants were removed from six patients, among whom one was diagnosed with endometrial cancer, four had an increased menstrual blood volume, and one entered menopause. In total, 14 patients were treated with subcutaneous etonogestrel implants for 3 years. Among these patients, the number of patients with heavy menstrual bleeding and high PBAC and VAS scores and serum CA125 levels was significantly decreased after implantation compared with that before implantation. In the eight patients with anemia, hemoglobin levels increased gradually. However, the uterine volumes did not significantly change. Bleeding patterns were changed but were tolerable.

Conclusion: Subcutaneous etonogestrel implants represent a new option for the clinical treatment of adenomyosis for patients who refuse surgery.

依托孕烯皮下埋植剂治疗子宫腺肌病20例临床观察 摘要

目的：评价皮下埋植依托孕烯治疗子宫腺肌病的疗效。方法：我们于2015年8月至2017年7月对20例子宫腺肌病患者进行了皮下埋植术的临床观察研究, 并随访36个月。我们主要根据以下指标来评估皮下埋植剂的疗效：月经量的图画失血评估表(PBAC)、出血模式的变化、痛经的视觉模拟评分(VAS)、子宫体积、血清癌症抗原125(CA125)水平、血红蛋白水平和副作用。结果：随访3年中, 6例患者取出皮下埋植剂, 其中1例诊断为子宫内膜癌, 4例月经血量增加, 1例进入绝经。总共有14例患者接受了3年的皮下埋植依托孕烯治疗。其中PBAC月经量大、VAS评分高、血清CA125水平高的患者数量植入后较植入前明显减少(P<0.05)。在8例贫血患者中, 血红蛋白水平逐渐升高。但子宫体积无明显变化。出血模式有所改变, 但仍可耐受。结论：对于拒绝手术的子宫腺肌病患者, 皮下植入依托孕烯是一种新的选择。

Keywords:

• Subcutaneous etonogestrel implants
• adenomyosis
• Implanon
• medical therapy

Acknowledgements

Patients have provided informed consent for publication of the study.

Disclosure statement

No potential conflicts of interest were reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

The research was supported by Scientific Research Foundation of Qilu Hospital of Shandong University (Qingdao) (No. QDKY2016LH01).