4.6 Review

Current Medical Therapy for Adenomyosis: From Bench to Bedside

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Various types of adenomyosis and endometriosis: in search of optimal management

Sun-Wei Guo

Summary: Currently, hormonal drugs are the main treatment for endometriosis or adenomyosis, but their lack of innovation and failure to target specific areas is concerning. The failure to understand the natural history of the ectopic endometrium has led to many unsuccessful nonhormonal drug research projects. This review aims to explore new concepts in the progression of ectopic endometrium and provide insights for better therapeutic options.

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Mauro Cozzolino et al.

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Summary: This review aims to evaluate cases of concurrent adenomyosis and congenital uterine anomalies (CUAs). The literature search retrieved 14 articles summarizing the findings regarding the concurrent diagnosis of adenomyosis and CUAs. Adenomyosis can be found in both syndromic and nonsyndromic CUAs, and the underlying mechanisms and contributing factors need further elucidation.

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Summary: This study investigated the efficacy of Relugolix (REL) in reducing uterine volume and clinical symptoms in the treatment of adenomyosis. A retrospective cohort study was conducted on patients who received REL and underwent a hysterectomy. The results showed that REL significantly decreased uterine volume and adenomyotic lesions, and relieved symptoms (amenorrhea, pelvic pain, and anemia).

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Changes in adenomyosis following elagolix vs leuprolide treatment in a patient with pelvic pain and infertility: A case report

Mariam Barseghyan et al.

Summary: Adenomyosis, a form of uterine endometriosis, presents unique challenges in infertility treatment. The novel oral drug elagolix may not be as effective as the injectable drug leuprolide acetate in managing pain associated with endometriosis.

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Rituximab for endometriosis: Unlikely translatability from oncology due to safety concerns?

Fabio Barra et al.

Summary: This letter discusses a study by Dogan et al. that evaluated the potential therapeutic efficacy of rituximab in an experimental animal model of endometriosis. The study showed promising results, but rituximab is typically used for lymphocyte malignancies and has potential side effects. Further preclinical research is needed to evaluate its safety and efficacy in humans.

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Intralipid infusion therapy as an adjunct treatment in women experiencing adenomyosis-related infertility

James Henshaw et al.

Summary: This study investigated the use of prednisolone or Intralipid immune therapy in combination with GnRH agonist LDR for improving fertility outcomes in adenomyosis patients. The results showed that adding Intralipid significantly increased live birth rates, while adding prednisolone did not provide additional benefits.

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Ana Maria Alcalde et al.

Summary: Women with deep infiltrating endometriosis (DIE) experience impaired quality of life, which may improve with the use of combined oral contraceptives (COCs) containing dienogest and ethinyl estradiol. Patients with DIE and associated adenomyosis (AD) have poorer sexual quality of life and more intense pain symptoms. After 12 months of treatment, both groups showed significant improvement in overall and sexual quality of life.

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Treatment of symptomatic uterine adenomyosis with linzagolix, an oral gonadotrophin-releasing hormone antagonist: a pilot study

Jacques Donnez et al.

Summary: A once-daily regimen of linzagolix at a fully suppressive dose of 200 mg for 12 weeks, followed by a partially suppressive dose of 100 mg for another 12 weeks, reduced adenomyotic uterine size and improved associated symptoms.

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Yongmiao Pan et al.

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A controlled clinical trial comparing potent progestins, LNG-IUS and dienogest, for the treatment of women with adenomyosis

Ikuko Ota et al.

Summary: The study found that LNG-IUS and DNG were similarly effective in reducing pain scores for patients with adenomyosis. However, DNG showed superior efficacy in pain control and reducing days of bleeding compared to LNG-IUS.

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Comparison of dienogest versus combined oral contraceptive pills in the treatment of women with adenomyosis: A randomized clinical trial

Ahmed Hassanin et al.

Summary: This study compared the efficacy and safety of dienogest with combined oral contraceptives for treating adenomyosis-associated symptoms. Results showed that dienogest was more effective in reducing pain, improving bleeding pattern, decreasing uterine volume, and uterine artery blood flow, but had a higher rate of side effects.

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Ulipristal acetate use in adenomyosis: A randomized controlled trial

Perrine Capmas et al.

Summary: This study evaluated the effect of UPA on abnormal uterine bleeding due to adenomyosis, showing a significantly higher rate of women with PBAC score under 75 in the UPA group compared to the placebo group after 28 days of treatment, along with a significant reduction in pain for the UPA group. At 6 months, there was no significant difference in outcomes between the two groups, indicating that UPA could be a potential option for treating this condition.

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The function role and synergic effect of syndecan-1 for mifepristone in uterine leiomyoma

Xiaoyan Shen et al.

Summary: The study revealed that syndecan-1 silencing inhibits cell proliferation, ECM, and MMPs in human uterine leiomyoma cells and enhances the effects of mifepristone. Targeting syndecan-1 represents a novel therapeutic strategy for treating uterine leiomyoma.

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Use of Ulipristal Acetate and Risk of Liver Disease: A Nationwide Cohort Study

Eileen L. Yoon et al.

Summary: In patients with uterine fibroids, the incidence of total liver disease and mild liver disease was higher in the UPA group than in the GnRH agonist group, while the incidence of severe liver disease and toxic liver disease did not differ between the groups.

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Uterine Adenomyosis Treated by Linzagolix, an Oral Gonadotropin-Releasing Hormone Receptor Antagonist: A Pilot Study with a New 'Hit Hard First and then Maintain' Regimen of Administration

Jacques Donnez et al.

Summary: The study demonstrated that using 200 mg/day of linzagolix can reduce uterine volume and improve clinical symptoms, while continuing with 100 mg/day can maintain treatment benefits and minimize side effects. This 'hit hard first and then maintain' approach may be the optimal way to treat women with symptomatic adenomyosis.

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Pierre-Alexandre Just et al.

Summary: Different types of endometriosis represent distinct clinico-pathological entities, and pathologists should be able to recognize them. The statistical association between endometriosis and various ovarian tumors has been established, with certain molecular and morphological features supporting the potential for transformation.

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Ricardo Jorge Dinis-Oliveira et al.

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Susan Dababou et al.

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