Maintenance dienogest therapy following adjuvant gonadotropin‐releasing hormone agonist treatment after uterus‐sparing surgery in adenomyosis: A retrospective cohort study

• Published in: International journal of gynecology and obstetrics Vol. 161; no. 3; pp. 751 - 759
• Main Authors: Chan, I‐San, Hsu, Teh‐Fu, Shih, Ying‐Chu, Chang, Yen‐Hou, Wang, Peng‐Hui, Chen, Yi‐Jen
• Format: Journal Article
• Language: English
• Published: United States 01.06.2023
• Subjects: adenomyoma; adenomyosis; Adenomyosis - drug therapy; Adenomyosis - surgery; dienogest; Female; GnRH agonist; Gonadotropin-Releasing Hormone; Humans; maintenance therapy; Retrospective Studies; Uterus - surgery; uterus‐sparing surgery; maintenance therapy; adenomyoma; uterus-sparing surgery; dienogest; GnRH agonist; adenomyosis
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.14635

Objective To investigate the safety and efficacy of adjuvant gonadotropin‐releasing hormone agonist (GnRH‐a) treatment followed by maintenance dienogest (DNG) therapy after uterus‐sparing surgery. Methods Retrospective cohort study. A total of 190 patients with severe adenomyosis underwent uterus‐sparing surgery between January 2010 and June 2020. Of these patients, 90 were analyzed. Forty‐six patients (control group) received adjuvant 6‐month GnRH‐a therapy alone after uterus‐sparing surgery, and 44 patients (maintenance group) received postoperative 6‐month GnRH‐a treatment followed by maintenance DNG therapy (2 mg/day orally). The median follow‐up period was 18 months. The study was analyzed using generalized estimating equations. Results At baseline, the characteristics of patients in each group were comparable. Compared with the control group, the maintenance group had a significant improvement in the visual analog scale score of dysmenorrhea (P < 0.001), hemoglobin level (P = 0.004), and uterine volume (P = 0.004) from baseline to 18 months after uterus‐sparing surgery. The symptom recurrence rate was significantly lower in the maintenance group than in the control group (4.6% vs. 37.0%, P < 0.001). Conclusions The findings of this study suggest that combinatorial treatment with GnRH‐a (adjuvant treatment) and DNG (maintenance therapy) represents a safe and effective short‐term therapy after uterus‐sparing surgery for adenomyosis. Synopsis Maintenance DNG therapy following adjuvant GnRH‐a treatment after uterus‐sparing surgery was identified as an effective therapy for symptom control and prevention of recurrent adenomyosis.