Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma

Objective: To compare the efficacy of surgical-medical treatment and surgery alone in the treatment of uteri symptomatic adenomyoma. Design: Prospective nonrandomized study. Setting: Medical centers. Patient(s): One hundred sixty-five women treated with conservative adenomyomectomy. Intervention(s): Surgery followed by six-course treatment (n=114, surgical-medical group) or no treatment (n=51, surgery-alone group) with a gonadotropin-releasing hormone (GnRH) agonist regimen. Main Outcome Measure(s): Symptom relief (scale: 0, no symptoms, to 5, worst symptoms) and relapse (when any one scale was >= 2 after treatment) during the 2-year follow-up period. Result(s): The general characteristics of the patients were similar in both groups, except for the diameter of the adenomyoma and age. Patients in both groups had statistically significant symptom relief, and all symptom scores declined from a mean of 3 or 4 to a mean of I or less at the end of the 2-year follow-up period. The symptom-relapse rates in the surgical-medical group were statistically significantly lower than those in the surgery alone group (n=32, 28.1% vs. n=25, 49.0%, respectively). Conclusion(s): Conservative surgery, regardless of GnRH agonist treatment, may be acceptable for management of a selected population with severe symptomatic adenomyoma. However, surgical-medical treatment provide more effective symptom control (a lower symptom relapse rate) than surgery alone during the 2-year follow-up period. (Fertil Steril (R) 2009;92:876-85. (C)2009 by American Society for Reproductive Medicine.)