Ono Natsumi, Asano Ryoko, Nagai Koichi, Sugo Yoshinobu, Nakamura Tomomi, Miyagi Etsuko
Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
J Obstet Gynaecol Res. 2021 Apr;47(4):1433-1440. doi: 10.1111/jog.14612. Epub 2021 Feb 15.
Dienogest (DNG) is highly effective for relieving pain caused by endometriosis and adenomyosis. However, women with severe uterine swelling due to adenomyosis who take DNG usually experience metrorrhagia. This study aimed to examine the safety of DNG usage in women with adenomyosis.
This study included 20 women who were prescribed DNG for adenomyosis in our hospital from January 2016 to December 2016. We retrospectively analyzed women's clinical background characteristics (age, the use of the gonadotropin-releasing hormone agonist as pre-treatment of DNG, the uterus size [major axis, minor axis, maximum thickness in the myometrium, and length of the uterine body] by transvaginal ultrasonography [TVUS], hemoglobin level, and the presence of metrorrhagia during treatment). These variables were compared between the DNG continuation and discontinuation groups using the Mann-Whitney U test.
Thirteen women continued DNG, and seven discontinued DNG within 12 months because of metrorrhagia. The uterine size was significantly larger in the discontinuation group than in the continuation group. All uterine measurements had high Spearman rank correlation coefficients (ρ > 0.8, P < 0.05). In six of seven cases in the discontinuation group, adenomyosis was in the anterior wall. Measuring the uterus size and locating adenomyosis by TVUS are simple methods of predicting DNG discontinuation.
We consider that DNG can be safely administered in women with adenomyosis if the uterine size is <6 cm in the minor axis and the main lesion of adenomyosis is located in the posterior uterine wall.
地诺孕素（DNG）对缓解子宫内膜异位症和子宫腺肌病引起的疼痛非常有效。然而，因子宫腺肌病导致子宫严重肿大的女性服用DNG时通常会出现子宫出血。本研究旨在探讨DNG在子宫腺肌病女性中的使用安全性。
本研究纳入了2016年1月至2016年12月期间在我院因子宫腺肌病而开具DNG处方的20名女性。我们回顾性分析了这些女性的临床背景特征（年龄、使用促性腺激素释放激素激动剂作为DNG的预处理、经阴道超声检查[TVUS]测量的子宫大小[长径、短径、肌层最大厚度和子宫体长]、血红蛋白水平以及治疗期间子宫出血的情况）。使用Mann-Whitney U检验比较DNG持续使用组和停用组之间的这些变量。
13名女性继续使用DNG，7名女性因子宫出血在12个月内停用DNG。停用组的子宫大小明显大于继续使用组。所有子宫测量值均具有较高的Spearman等级相关系数（ρ>0.8，P<0.05）。在停用组的7例病例中有6例子宫腺肌病位于前壁。通过TVUS测量子宫大小并定位子宫腺肌病是预测DNG停用的简单方法。
我们认为，如果子宫短径<6cm且子宫腺肌病的主要病变位于子宫后壁，DNG可安全地用于子宫腺肌病女性。
