Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

Compare the Efficacy of Dienogest and the Levonorgestrel Intrauterine System in Women with Adenomyosis

PURPOSE

The goal of this study was to examine the efficacy and safety of the levonorgestrel intrauterine system (LNG-IUS) versus dienogest (DNG) in female subjects with symptomatic uterine adenomyosis.

METHODS

This study enrolled 117 women with symptomatic adenomyosis who visited our hospital from May 1, 2019, to June 30, 2022. Participants were randomized to either the LNG-IUS group (n = 48) or the DNG group (n = 79) in an as-controlled clinical trial for 36 months. Visual analog scale (VAS) scores, uterine volume, endometrial thickness, serum carcinoma antigen 125 level, estradiol, follicle-stimulating hormone, luteinizing hormone, and side effects were assessed to compare the efficacy of LNG-IUS and DNG.

FINDINGS

The VAS pain score was significantly decreased in both groups after 3 months of treatment. Three months later, patients receiving DNG reported significantly lower VAS scores compared with those treated with LNG- IUS (P < 0.05). Compared with LNG-IUS, DNG effectively controlled uterine volume growth after 12 months of treatment but neither significantly reduced uterine volume. During the treatment period, endometrial thickness in both groups was maintained at 0.4 to 0.7 cm.

IMPLICATIONS

Both DNG and LNG-IUS significantly improved adenomyosis-associated pain after 3 months of treatment. Compared with LNG-IUS, DNG was shown to continuously relieve the symptoms of pain and effectively control the growth of uterine volume.

Long-term treatment of dienogest with symptomatic adenomyosis: retrospective analysis of efficacy and safety in clinical practice

Objective: To evaluate the efficacy and safety of dienogest (DNG) in women with symptomatic adenomyosis.Methods: Women with symptomatic adenomyosis were included in this retrospective observation study. Group 1 (maximum uterine dimension ≥ 100.0 mm) began DNG after 4 months of GnRH-a administration, Group 2 (maximum uterine dimension < 100.0 mm) received DNG with no prior GnRH-a treatment. All women were assessed for their pain symptoms, uterine size, adverse effects and laboratory hematology at baseline and every 6 months during the treatment.Results: 123 women were enrolled in this study, in Group 1 (71 women) with severe uterine enlargement, the median VAS score was 80 mm prior to GnRH-a administration and 10, 10, 10, 20, and 20 mm, respectively, after 0, 6,12,18, and 24 months of DNG treatment. The mean uterine volume decreased from 262.9 ml to 104.7 ml after GnRH-a therapy, and slowly increased from 104.7 ml to 139.5 ml after 24 month-treatment of DNG. Another 52 women with mild uterine enlargement received DNG without prior GnRH-a administration, median VAS score was 70 mm at baseline and decreased to 20, 20, 10, and 10 mm at 6,12,18, and 24 months. The mean uterine volume slightly decreased from 157.9 ml to 153.3 ml after 24 months of DNG treatment (p > 0.05). All laboratory parameters were in the normal range.Conclusions: DNG is effective and well tolerated as a long-term treatment for symptomatic adenomyosis, and it can be used as maintenance therapy after discontinuation of GnRH-a administration.

Classifications of Adenomyosis and Correlation of Phenotypes in Imaging and Histopathology to Clinical Outcomes: a Review

Purpose of Review

To provide an update on published classification and reporting systems for adenomyosis. There is an urgent need to standardize reporting of various phenotypes of adenomyosis into a validated and globally recognized system. This can be used to examine the nature and severity of adenomyosis symptoms and inform the design, evaluation, and implementation of appropriate treatment options.

Recent Findings

In recent years, several new proposals for adenomyosis classification have emerged. Most are MRI-based and include features such as uterine size, junctional zone thickness, size and location of the lesions, and distribution patterns. To date, none of those proposals has been validated. Only one recent classification based on transvaginal ultrasound was validated for interobserver congruence and correlated to clinical findings. However, the differentiation of diffuse and focal adenomyosis still lacks consensus. In addition, only a few authors advocated imaging-based definitions.

Summary

There is a need for one or a combination of a classification and reporting system for adenomyosis. To date, there is no widely accepted and validated system.

Impact of Adenomyosis on Women's Psychological Health and Work Productivity: A Comparative Cross-Sectional Study

Background: Quality of life in adenomyosis (AD) patients has been poorly investigated. Previous data suggest that AD has negative impact on the quality of life in these women. Methods: From September 2018 to December 2019, all consecutive female premenopausal patients aged ≥18 years diagnosed with AD by transvaginal ultrasound (TVU) were invited to participate in a comparative cross-sectional study. The Short Form-36-item (SF-36) health questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH). Data obtained from these patients were compared with women with normal-appearing myometrium in the TVU recruited during routine gynecological visits. The study was approved by the Clinical Research Ethics Committee of the Hospital Clinic (reference HCB/2018/0919). Results: One hundred three patients with AD and 214 without AD were analyzed. Patients with AD compared to those without AD showed significantly lower scores in all domains of the SF-36 questionnaire and mean (SD) higher scores in the HADS questionnaire for anxiety (10.06 [3.04] vs. 6.92 [2.98], p < 0.001) and depression (6.39 [3.89] vs. 2.74 [2.01], p < 0.002). Significant differences (p < 0.001) were also found for the percentages of absenteeism (12.2% vs. 1.1%), presenteeism (31.1% vs. 11.4%), overall work productivity loss (38.2% vs. 12.4%), and activity impairment (55.7% vs. 9.9%). The presence of AD was associated with higher yearly estimated indirect costs of €5161.32 (€7928.0 vs. €2460.8, p < 0.001). Conclusions: AD negatively affects women's health-related quality of life, psychological health, and work productivity, with impairment at work and daily activities, and higher risk for anxiety and depression.

Relation between uterine morphology and severity of primary dysmenorrhea

Objective

This study aimed to evaluate whether uterine dimensions including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness measurements have a role in the severity of primary dysmenorrhea in virgin girls.

Materials and Methods

Enrollment included 90 virgin girls suffering from primary dysmenorrhea. The girls were divided into three groups according to the severity of dysmenorrhea, which was determined by the visual analog scale (VAS). Patients with VAS scores of 8-10 comprised the severe primary dysmenorrhea group (n=30), 4-7 the moderate primary dysmenorrhea group (n=30), and 1-3 the mild primary dysmenorrhea group (n=30). Uterine characteristics including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness were measured by a high-resolution four-dimensional ultrasound device with real-time capacity. They were recorded to determine if they can be predictors of dysmenorrhea severity.

Results

Girls with severe primary dysmenorrhea were more likely to complain of midline pain as opposed to mild and moderate cases with lateral or diffuse pain. None of the uterine characteristics on ultrasonography examination were significant for predicting the severity of primary dysmenorrhea. There were no significant positive correlations between the dysmenorrhea severity and uterine corpus length, cervix length, and uterine volume degree. Any combination of the measured uterine features was not predictive for determining the severity of dysmenorrhea.

Conclusion

Ultrasonographic measurements of uterine dimensions in virgins have low accuracy for predicting the severity of pain in primary dysmenorrhea.

Changes in ultrasound uterine morphology and endometrial thickness during ovarian aging and possible associated factors: findings from a prospective study

OBJECTIVE

The aim of the study was to provide reference values for sonographic measurements of uterine morphology, quantify changes in uterine morphology across the menopausal transition, and identify possible factors associated with sonographic findings in uterine morphology.

METHODS

This is a longitudinal cohort study conducted in middle-aged Chinese women. Using transvaginal ultrasound, we measured morphologic parameters of the uterus (volume and endometrial thickness) under standardized conditions every year for over a decade.

RESULTS

Uterine volume begins to decrease before the final menstrual period and declines rapidly thereafter. Compared with a baseline measurement taken in the year of the final menstrual period, uterine volume decreased by 20% and 35% at the first year and second year of postmenopause, respectively. The rate of decrease was slower in the third year. Compared with endometrial thickness in the year of the final menstrual period, the figures for 2 and 3 years before the final menstrual period were 5% and 10% higher, while they decreased by 9% and 18% at the first and second year after the final menstrual period. Similarly, the endometrial thickness became relatively stable 3 years after the final menstrual cycle. These observations were fairly consistent across all women without uterine fibroids. Endometrial thickness was significantly positively associated with body mass index (P = 0.049) after adjusting for time and menopausal stage.

CONCLUSIONS

The figures for uterine volume and endometrial thickness decrease around menopause using ultrasound measurments with large reductions in the first and second year after the final menstrual period. A higher body mass index is associated with increased endometrial thickness.

Efficacy of Hormonal Therapies for Decreasing Uterine Volume in Patients with Adenomyosis

Study objective:

The aim of this study is to evaluate the efficacy of hormonal therapies for inhibiting an increase in uterine volume in patients with adenomyosis.

Design:

This was retrospective cohort study.

Setting:

This study was conducted at Nippon Medical School Musashikosugi Hospital.

Patients:

A total of 28 women diagnosed with adenomyosis using magnetic resonance imaging.

Methods:

After providing informed consent, patients were treated with gonadotropin-releasing hormone agonist (GnRHa group), a low-dose estrogen and progestin combination (LEP group), or dienogest (DNG group) for ≥16 weeks. Uterine volume was assessed using the formula for an ovoid; uterine volumes before and after 16 weeks of treatment were compared. A <5% increase in uterine volume at 16 weeks was considered to reflect inhibition of uterine volume increase and efficacy of the medication. We compared the efficacy rate among the groups.

Results:

In the GnRHa group, a significant reduction in uterine volume was noted, from 307.4 ± 230.1 to 177.9 ± 142.1 cm³ (P < 0.001). In the LEP and the DNG groups, there was no significant change (LEP: 226.7 ± 116.6 cm³ pre-treatment and 230.5 ± 128.6 cm³ post-treatment, P = 0.85; DNG: 232.6 ± 117.8 cm³ pre-treatment and 262.1 ± 136.8 cm³ post-treatment, P = 0.37). The number of responders (efficacy rate) in the GnRHa group, LEP group, and DNG group was 25/26 (96.2%), 7/15 (46.7%), and 6/11 (54.5%), respectively. The efficacy rate of GnRHa therapy was significantly higher than that of LEP or DNG therapy (P < 0.001 and P = 0.005, respectively).

Conclusion:

We conclude that the efficacy of GnRHa in reducing uterine volume should be considered when prescribing hormone therapy for adenomyosis.