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- Title
Current Medical Therapy for Adenomyosis: From Bench to Bedside.
- Authors
Etrusco, Andrea; Barra, Fabio; Chiantera, Vito; Ferrero, Simone; Bogliolo, Stefano; Evangelisti, Giulio; Oral, Engin; Pastore, Mariana; Izzotti, Alberto; Venezia, Renato; Ceccaroni, Marcello; Laganà, Antonio Simone
- Abstract
Adenomyosis, characterized by the growth of endometrial tissue within the uterine wall, poses significant challenges in treatment. The literature primarily focuses on managing abnormal uterine bleeding (AUB) and dysmenorrhea, the main symptoms of adenomyosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid provide limited support for mild symptoms or symptom re-exacerbation during hormone therapy. The levonorgestrel-releasing intrauterine system (LNG-IUS) is commonly employed in adenomyosis management, showing promise in symptom improvement and reducing uterine size, despite the lack of standardized guidelines. Dienogest (DNG) also exhibits potential benefits, but limited evidence hinders treatment recommendations. Danazol, while effective, is limited by androgenic side effects. Combined oral contraceptives (COCs) may be less effective than progestins but can be considered for contraception in young patients. Gonadotropin-releasing hormone (GnRH) agonists effectively manage symptoms but induce menopausal symptoms with prolonged use. GnRH antagonists are a recent option requiring further investigation. Aromatase inhibitors (AIs) show promise in alleviating AUB and pelvic pain, but their safety necessitates exploration and limited use within trials for refractory patients. This review highlights the complexity of diagnosing adenomyosis, its coexistence with endometriosis and uterine leiomyomas, and its impact on fertility and quality of life, complicating treatment decisions. It emphasizes the need for research on guidelines for medical management, fertility outcomes, long-term effects of therapies, and exploration of new investigational targets. Future research should optimize therapeutic strategies, expand our understanding of adenomyosis and its management, and establish evidence-based guidelines to improve patient outcomes and quality of life.
- Subjects
DIAGNOSIS of endometriosis; ENDOMETRIOSIS; HORMONE therapy; NONSTEROIDAL anti-inflammatory agents; TRANEXAMIC acid; LEVONORGESTREL; FERTILITY; QUALITY of life; SYMPTOMS; DECISION making in clinical medicine; COMORBIDITY; MEDICAL research; PATIENT safety; DISEASE complications
- Publication
Drugs, 2023, Vol 83, Issue 17, p1595
- ISSN
0012-6667
- Publication type
Article
- DOI
10.1007/s40265-023-01957-7