Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan.
Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
Gynecol Endocrinol. 2020 Jun;36(6):521-524. doi: 10.1080/09513590.2019.1683818. Epub 2019 Oct 29.
This study elucidated the degree of adenomyosis recurrence following gonadotropin-releasing hormone agonist (GnRHa) discontinuation and dienogest efficiency for recurrent adenomyosis. This retrospective cohort study included 30 patients, divided into a group of patients whose progress was observed without providing additional therapy following GnRHa administration for six months (Group G) and a group of patients administered dienogest for six months following six months of GnRHa administration (Group D). Menorrhagia, dysmenorrhea, chronic pelvic pain, abdominal fullness, and uterine volume were recorded prior to treatment, six months after the start of therapy (6 M), and 12 months after the start of therapy (12 M). In Group G ( = 15), although all subjective symptoms disappeared at 6 M, nearly all symptoms recurred at 12 M. Uterine volume significantly decreased from 341.0 cm to 156.0 cm at 6 M ( = .001) and significantly increased again to 282.3 cm at 12 M ( = .003). In Group D ( = 15), all subjective symptoms disappeared at 6 M, and only abdominal fullness returned in a significant number of patients (5 of 5; = .021) at 12 M. Uterine volume decreased significantly at 6 M ( = .003) and significantly increased again from 162.5 cm to 205.6 cm at 12 M ( = .006). Subjective symptoms, except for abdominal fullness, did not recur when dienogest was administered after GnRHa.
本研究阐明了促性腺激素释放激素激动剂(GnRHa)停药后子宫腺肌病的复发程度和地诺孕素治疗复发子宫腺肌病的效果。这项回顾性队列研究纳入了 30 名患者,分为两组:一组患者在接受 GnRHa 治疗 6 个月后不提供额外治疗(G 组),另一组患者在接受 GnRHa 治疗 6 个月后接受地诺孕素治疗 6 个月(D 组)。在治疗前、治疗开始后 6 个月(6M)和治疗开始后 12 个月(12M)记录了月经过多、痛经、慢性盆腔痛、腹部胀满和子宫体积。在 G 组(n=15),尽管所有的主观症状在 6M 时都消失了,但几乎所有的症状在 12M 时都复发了。子宫体积在 6M 时从 341.0cm 显著减少至 156.0cm(P=.001),在 12M 时又显著增加至 282.3cm(P=.003)。在 D 组(n=15),所有的主观症状在 6M 时都消失了,只有腹部胀满在 12M 时在大量患者中(5 例中的 5 例;P=.021)返回。子宫体积在 6M 时显著减少(P=.003),并在 12M 时再次从 162.5cm 显著增加至 205.6cm(P=.006)。在使用 GnRHa 后给予地诺孕素治疗时,除了腹部胀满外,其他主观症状没有复发。