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Semin Reprod Med 2020; 38(02/03): 151-156
DOI: 10.1055/s-0040-1719016
Review Article

Current and Future Medical Therapies for Adenomyosis

Adela G. Cope 
1   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
2   Division of Minimally Invasive Gynecology, Mayo Clinic, Rochester, Minnesota
3   Mayo Clinic Alix College of Medicine, Rochester, Minnesota
,
Alessandra J. Ainsworth
1   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
3   Mayo Clinic Alix College of Medicine, Rochester, Minnesota
4   Division of Reproductive Endocrinology, Mayo Clinic, Rochester, Minnesota
,
Elizabeth A. Stewart
1   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
3   Mayo Clinic Alix College of Medicine, Rochester, Minnesota
4   Division of Reproductive Endocrinology, Mayo Clinic, Rochester, Minnesota
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Abstract

There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence of concomitant gynecologic conditions. Most available evidence focuses on the treatment of heavy menstrual bleeding, painful menses, and pelvic pain. Data evaluating fertility outcomes, sexual function, and quality of life following treatment are lacking. Additionally, there is no disease-specific measure of quality of life for adenomyosis. The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy based on efficacy compared with oral agents, maintenance of steady-state hormonal levels, and contraceptive benefit. In areas where it is marketed, the progestin dienogest appears superior to combined oral contraceptives. Long-acting gonadotropin-releasing hormone agonists are effective and should be considered second-line therapy but are limited by hypogonadal effects. Additional data regarding oral gonadotropin-releasing hormone antagonists are required. While aromatase inhibitors demonstrate improvement in heavy menstrual bleeding and pelvic pain, further research is needed to determine their role in the management of adenomyosis. Progesterone receptor modulators may have a role for this disease if released again to market with appropriate safety parameters. Finally, modulation of prolactin and/or oxytocin may provide novel nonsteroidal treatment options.

Keywords

adenomyosis treatment - heavy menstrual bleeding - painful menses - infertility


Publication History

Article published online:
29 October 2020

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