Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy.
Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
Fertil Steril. 2018 Mar;109(3):398-405. doi: 10.1016/j.fertnstert.2018.01.013.
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.
子宫腺肌病是一种良性子宫疾病，影响着不同年龄、不同症状的女性。这些患者的治疗方法仍存在争议。目前针对子宫腺肌病的药物或手术治疗的临床研究很少。没有专门针对子宫腺肌病的药物，也没有具体的治疗指南。然而，药物治疗在改善症状（疼痛、异常子宫出血和不孕）方面是有效的。使用药物治疗的依据是子宫腺肌病的发病机制：性激素异常、细胞凋亡受损和炎症增加。目前，一些非激素（如非甾体抗炎药）和激素治疗（如孕激素、口服避孕药、促性腺激素释放激素类似物）被超适应证用于控制子宫腺肌病的疼痛症状和异常子宫出血。促性腺激素释放激素类似物在生育治疗前用于控制疼痛症状，以提高患有子宫腺肌病的不孕妇女的妊娠机会。孕激素（如地诺孕素、丹那唑和左炔诺孕酮醋酸酯）具有抗增殖和抗炎作用，这表明它们可用于子宫腺肌病的药物治疗，主要用于控制疼痛症状。另一方面，左炔诺孕酮宫内节育器可有效地控制异常子宫出血和减少子宫体积，是长期管理计划中的一种有效方法。基于发病机制的新发现，正在开发用于治疗子宫腺肌病的新药，如选择性孕激素受体调节剂、芳香化酶抑制剂、丙戊酸和抗血小板治疗。
