Cope Adela G, Ainsworth Alessandra J, Stewart Elizabeth A
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
Division of Minimally Invasive Gynecology, Mayo Clinic, Rochester, Minnesota.
Semin Reprod Med. 2020 May;38(2-03):151-156. doi: 10.1055/s-0040-1719016. Epub 2020 Oct 29.
There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence of concomitant gynecologic conditions. Most available evidence focuses on the treatment of heavy menstrual bleeding, painful menses, and pelvic pain. Data evaluating fertility outcomes, sexual function, and quality of life following treatment are lacking. Additionally, there is no disease-specific measure of quality of life for adenomyosis. The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy based on efficacy compared with oral agents, maintenance of steady-state hormonal levels, and contraceptive benefit. In areas where it is marketed, the progestin dienogest appears superior to combined oral contraceptives. Long-acting gonadotropin-releasing hormone agonists are effective and should be considered second-line therapy but are limited by hypogonadal effects. Additional data regarding oral gonadotropin-releasing hormone antagonists are required. While aromatase inhibitors demonstrate improvement in heavy menstrual bleeding and pelvic pain, further research is needed to determine their role in the management of adenomyosis. Progesterone receptor modulators may have a role for this disease if released again to market with appropriate safety parameters. Finally, modulation of prolactin and/or oxytocin may provide novel nonsteroidal treatment options.
目前尚无针对子宫腺肌病的获批药物治疗方法，且由于非组织学诊断的复杂性以及合并妇科疾病的普遍性，指导治疗的证据有限。大多数现有证据集中在治疗月经过多、痛经和盆腔疼痛方面。缺乏评估治疗后生育结局、性功能和生活质量的数据。此外，对于子宫腺肌病，尚无特定疾病的生活质量衡量标准。与口服药物相比，基于疗效、维持稳态激素水平以及避孕益处，左炔诺孕酮宫内缓释系统似乎是最有效的一线治疗方法。在其上市的地区，孕激素地诺孕素似乎优于复方口服避孕药。长效促性腺激素释放激素激动剂有效，应被视为二线治疗方法，但受性腺功能减退影响的限制。需要更多关于口服促性腺激素释放激素拮抗剂的数据。虽然芳香化酶抑制剂可改善月经过多和盆腔疼痛，但需要进一步研究以确定它们在子宫腺肌病管理中的作用。如果孕激素受体调节剂能在具备适当安全参数的情况下再次上市，可能对这种疾病有作用。最后，调节催乳素和/或催产素可能提供新的非甾体治疗选择。
