Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review

PURPOSE

Medical management of adenomyosis largely revolves around symptom management, with very few drugs having received regulatory approval for the disease. However, the level of evidence supporting the use of pharmacological interventions is low, making it difficult to establish their efficacy in the treatment of adenomyosis. Hence, the aim of our systematic review is to identify the strength of evidence currently available and evaluate the effectiveness of different medical interventions in the management of adenomyosis.

METHODS

The search was performed in MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov. Articles published between 1 January 2010 and 30 November 2020 were considered. Randomized controlled trials and observational studies that assessed the efficacy of medical interventions in patients with adenomyosis were included. The quality of the data was analyzed using RevMan 5.3 software.

RESULTS

LNG-IUS (levonorgestrel intrauterine system), dienogest and gonadotropin-releasing hormone (GnRH) analogues were effective in reducing pain, uterine volume and menstrual bleeding. However, these data were largely obtained in the non-trial setting and were fraught with issues that included patient selection, short duration of therapy, small sample size, and limited long-term safety and effectiveness data.

CONCLUSIONS

Although LNG-IUS, dienogest and GnRH analogues have better evidence for effectiveness in adenomyosis, the need of the hour is to thoroughly evaluate other novel molecules for adenomyosis using well-designed randomized controlled trials.

The Effectiveness of Levonorgestrel-Releasing Intrauterine System in the Treatment of Heavy Menstrual Bleeding

OBJECTIVE

Levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to be an effective treatment for patients with abnormal uterine bleeding (AUB) in many Western studies. The purpose of study was to examine the effectiveness of LNG-IUS in the treatment of Indian women with AUB.

METHODS

We conducted a retrospective observational study of 70 women diagnosed with AUB and treated with LNG-IUS insertion between February 2010 and 2014 at the Department of Gynecology of Sree Narayana Institute of Medical Sciences. Baseline endometrial biopsies were done before insertion of LNG-IUS, and outpatient follow-up with symptom diary was undertaken at 3-month intervals after insertion of LNG-IUS.

RESULTS

Primary outcome in the two treatment groups was significantly greater among women assigned to levonorgestrel-IUS than among those assigned to usual treatment (mean difference in scores over the course of 1 year 13.4 points; 95 % confidence interval [CI] 9.9-16.9; P < 0.001). All six domains of the MMAS favored the levonorgestrel-IUS at every time point (P < 0.001) with the use of a test for trend.

CONCLUSION

In conclusion, our study showed that both the levonorgestrel-IUS and usual medical treatments reduced the adverse effect of menorrhagia on women's lives over the course of 2 years, but the levonorgestrel-IUS was the more effective first choice, as assessed by the impact of bleeding on the women's quality of life.