Ota Kuniaki, Takahashi Toshifumi, Shiraishi Satoru, Mizunuma Hideki
Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan.
Department of Obstetrics and Gynecology, Nasu Red Cross Hospital, Tochigi, Japan.
J Obstet Gynaecol Res. 2018 Sep;44(9):1787-1792. doi: 10.1111/jog.13720. Epub 2018 Jul 12.
Menorrhagia and dysmenorrhea are common symptoms. Uterine adenomyosis is one of the causes of menorrhagia and dysmenorrhea. These symptoms often decrease the quality of life in women. Microwave endometrial ablation (MEA) is a recently developed procedure that enables endometrial ablation. Dienogest has long been used to suppress endometrium development and reduce adenomyosis-related dysmenorrhea. However, some cases could be resistant to dienogest. In this study, we evaluated the efficacy of a combination of MEA and postoperative dienogest in reducing adenomyosis-related dysmenorrhea and menorrhagia.
Ten patients with hormone treatment-resistant symptomatic adenomyosis underwent MEA and were administered oral dienogest after the procedure. The primary endpoints were reduction in pain recurrence and anemia. The secondary endpoint was a change in the adenomyosis lesion and its symptomatic recurrence.
Statistically significant improvements were seen in the visual analog scale score and hemoglobin levels in women post-treatment. The difference in myometrial thickness pre- and post-MEA was statistically significant. There were no cases of symptomatic recurrence.
The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea.
月经过多和痛经是常见症状。子宫腺肌病是月经过多和痛经的病因之一。这些症状常降低女性的生活质量。微波子宫内膜消融术（MEA）是一种最近开发的能够实现子宫内膜消融的手术。地诺孕素长期以来一直用于抑制子宫内膜生长并减轻与腺肌病相关的痛经。然而，一些病例可能对地诺孕素耐药。在本研究中，我们评估了MEA与术后使用地诺孕素联合治疗减轻与腺肌病相关的痛经和月经过多的疗效。
10例有症状且对激素治疗耐药的腺肌病患者接受了MEA，并在术后给予口服地诺孕素。主要终点是疼痛复发和贫血的减轻。次要终点是腺肌病病灶及其症状复发的变化。
治疗后女性的视觉模拟评分和血红蛋白水平有统计学意义的改善。MEA前后肌层厚度的差异有统计学意义。没有症状复发的病例。
MEA与术后地诺孕素联合治疗对治疗伴有月经过多和痛经的子宫腺肌病有效。
