Efficacy of Hormonal Therapies for Decreasing Uterine Volume in Patients with Adenomyosis

Abstract

Study objective: The aim of this study is to evaluate the efficacy of hormonal therapies for inhibiting an increase in uterine volume in patients with adenomyosis.

Design: This was retrospective cohort study.

Setting: This study was conducted at Nippon Medical School Musashikosugi Hospital.

Patients: A total of 28 women diagnosed with adenomyosis using magnetic resonance imaging.

Methods: After providing informed consent, patients were treated with gonadotropin-releasing hormone agonist (GnRHa group), a low-dose estrogen and progestin combination (LEP group), or dienogest (DNG group) for ≥16 weeks. Uterine volume was assessed using the formula for an ovoid; uterine volumes before and after 16 weeks of treatment were compared. A <5% increase in uterine volume at 16 weeks was considered to reflect inhibition of uterine volume increase and efficacy of the medication. We compared the efficacy rate among the groups.

Results: In the GnRHa group, a significant reduction in uterine volume was noted, from 307.4 ± 230.1 to 177.9 ± 142.1 cm³ (P < 0.001). In the LEP and the DNG groups, there was no significant change (LEP: 226.7 ± 116.6 cm³ pre-treatment and 230.5 ± 128.6 cm³ post-treatment, P = 0.85; DNG: 232.6 ± 117.8 cm³ pre-treatment and 262.1 ± 136.8 cm³ post-treatment, P = 0.37). The number of responders (efficacy rate) in the GnRHa group, LEP group, and DNG group was 25/26 (96.2%), 7/15 (46.7%), and 6/11 (54.5%), respectively. The efficacy rate of GnRHa therapy was significantly higher than that of LEP or DNG therapy (P < 0.001 and P = 0.005, respectively).

Conclusion: We conclude that the efficacy of GnRHa in reducing uterine volume should be considered when prescribing hormone therapy for adenomyosis.

Keywords: Adenomyosis; dienogest; ethinyl estradiol; ferrous fumarate drug combination; gonadotropin-releasing hormone; norethindrone acetate.

Figure 1

Uterine volume in each treatment group before and after 16 weeks of hormonal therapy. Uterine volumes before and after administration of each hormonal treatment indicates that uterine volume was significantly reduced in the GnRHa group, but in the LEP and DNG groups, there was a slight increase in uterine volume after treatment, but this increase was not statistically significant. *: P < 0.001

Figure 2

Efficacy rate for each hormonal treatment group. The GnRHa group had a significantly higher efficacy rate than that seen in the LEP and DNG groups (P < 0.001, P = 0.005). Efficacy ratio. GnRHa: 96.2% (25/26). LEP: 46.7% (7/15)*, DNG: 54.5% (6/11)**, *<0.001, ** = 0.005. GnRHa: Gonadotropin-releasing hormone agonist, LEP: Low-dose estrogen-progestin combinations, DNG: Dienogest