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Role of medical therapy in the management of uterine adenomyosis
Open accessAbstract
Adenomyosis is a benign uterine condition affecting women at various ages with different symptoms. The management of these patients is still controversial. Few clinical studies focusing on medical or surgical treatment for adenomyosis have been performed. No drug is currently labelled for adenomyosis and there are no specific guidelines to follow for the best management. Anyhow, medical treatments are effective in improving symptoms (pain, abnormal uterine bleeding and infertility). The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis: sex steroid hormones aberrations, impaired apoptosis, and increased inflammation. Several nonhormonal (i.e., nonsteroidal anti-inflammatory drugs) and hormonal treatments (i.e., progestins, oral contraceptives, gonadotropin-releasing hormone analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding in adenomyosis. Gonadotropin-releasing hormone analogues are indicated before fertility treatments to improve the chances of pregnancy in infertile women with adenomyosis. An antiproliferative and anti-inflammatory effect of progestins, such as dienogest, danazol and norethindrone acetate, suggests their use in medical management of adenomyosis mainly to control pain symptoms. On the other hand, the intrauterine device releasing levonorgestrel resulted is extremely effective in resolving abnormal uterine bleeding and reducing uterine volume in a long-term management plan. Based on new findings on pathogenetic mechanisms, new drugs are under development for the treatment of adenomyosis, such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelets therapy.
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“The clinical treatment strategy for the two diseases also seems to be similar, and the drugs to treat the two diseases can be used interchangeably [11].”
From The Pathogenesis of Adenomyosis vis-à-vis Endometriosis (2020) · cites this paper as [11]
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Metadata
- Authors
- Vannuccini, S., Luisi, S., Tosti, C., Sorbi, F., & Petraglia, F.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Siena (IT)
- Corresponding author
- Petraglia, Felice
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 109
- Issue
- 3
- Pages
- 398-405
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2790094279
- Cited by
- 231
- References
- 103
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 33 · 2023: 37 · 2022: 40 · 2021: 38 · 2020: 20 · 2019: 17 · 2018: 2
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- adenomyosis, medical therapy, hormone therapy, GnRH analogues, progestins, dienogest, danazol, norethindrone acetate, levonorgestrel intrauterine device, nonsteroidal anti-inflammatory drugs, abnormal uterine bleeding, dysmenorrhea, infertility, sex hormones, apoptosis, inflammation, selective progesterone receptor modulators, aromatase inhibitors, valproic acid, antiplatelet therapy
- MeSH terms
- Animals, Anti-Inflammatory Agents, Non-Steroidal, Female, Fertility Agents, Female, Humans, Intrauterine Devices, Medicated, Gonadotropin-Releasing Hormone, Progestins, Uterine Diseases, Drugs, Investigational, Treatment Outcome, Adenomyosis
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