An update on the pharmacological management of adenomyosis.

Abstract

INTRODUCTION:

Adenomyosis, characterized by the infiltration of the myometrium by ectopic endometrial islets, is a common condition that causes dysmenorrhea, abnormal uterine bleeding and infertility. Different treatment options exist, including medical and surgical treatments. The most commonly used medications are NSAIDs, progestogens and GnRH agonists (GnRHas).

AREAS COVERED:

We conducted a literature search for in vitro and animal studies, randomized and non-randomized studies, systematic reviews and ongoing trials registered on ClinicalTrials.gov. There are almost no well-conducted randomized controlled trials on the pharmacological treatment of adenomyosis and the information collected from published studies is insufficient. Several therapeutic targets have been identified through animal and in vitro studies, and it is hoped that they will lead to further clinical studies on new compounds and treatment targets in this heterogeneous disease.

EXPERT OPINION:

Hysterectomy is very effective at treating women with symptomatic adenomyosis who have completed their wish of pregnancy. For women with a future desire of pregnancy medical treatments remain the best options. Progestogens and GnRHas are the most frequently used long-term treatments for abnormal uterine bleeding and pain symptoms. In assisted reproductive techniques long agonist stimulation protocols and pretreatment with GnRHas for differed embryo transfer seem to improve pregnancy rates.

• Authors: Isabelle Streuli, Jean Dubuisson, Pietro Santulli, Dominique de Ziegler, Frédéric Batteux, Charles Chapron
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 15 Issue 16 Pg. 2347-60 (Nov 2014) ISSN: 1744-7666 [Electronic] England
• PMID: 25196637 (Publication Type: Journal Article, Review)

Chemical References

• Angiogenesis Inhibitors
• Anti-Inflammatory Agents, Non-Steroidal
• Progestins
• Receptors, LHRH
• Gonadotropin-Releasing Hormone

Topics

• Adenomyosis (complications, drug therapy, physiopathology)
• Angiogenesis Inhibitors (therapeutic use)
• Animals
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Clinical Trials as Topic
• Female
• Gonadotropin-Releasing Hormone (agonists)
• Humans
• Infertility, Female (etiology, therapy)
• Metrorrhagia (etiology)
• Pelvic Pain (drug therapy)
• Progestins (therapeutic use)
• Receptors, LHRH (antagonists & inhibitors)
• Reproductive Techniques, Assisted