Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt.
Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt.
J Gynecol Obstet Hum Reprod. 2024 Sep;53(7):102795. doi: 10.1016/j.jogoh.2024.102795. Epub 2024 May 8.
Adenomyosis is a gynaecological problem that impacts women's quality of life by causing dysmenorrhea, chronic pelvic pain, and menorrhagia. The search continues for the best medical treatment for symptomatic adenomyosis. This systematic review and meta-analysis investigated the role of dienogest, an oral progestin, in reducing pain and bleeding associated with adenomyosis. Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, Scopus, and Web of Science were searched in January 2024. The primary outcome was pain scores for dysmenorrhea, whereas secondary outcomes were chronic pelvic pain (CPP), uterine volume (UV), and menorrhagia. One comparison was performed comparing outcomes in symptomatic adenomyosis before and after treatment with dienogest. Pooled analysis of included studies reported a statistically significant reduction of dysmenorrhea pain score after dienogest treatment (mean difference -5.86 cm on a 10-cm visual analogue scale, 95 % CI -7.20 to -4.53, I2 = 97 %). Regarding chronic pelvic pain, a meta-analysis of included studies showed a significant decline in pain after treatment (standardized mean difference -2.37, 95 % CI -2.89 to -1.86, I2 = 60 %). However, uterine volume did not differ significantly after treatment (mean difference -4.65 cm, 95 % CI -43.22 to 33.91). Menorrhagia was improved significantly after treatment (Peto odds ratio 0.07, 95 % CI 0.03 to 0.18). In conclusion, dienogest seems to be effective in controlling painful symptoms and uterine bleeding in women with adenomyosis at short and long-term therapy.
子宫腺肌病是一种妇科问题，会导致痛经、慢性盆腔痛和月经过多，从而影响女性的生活质量。目前仍在寻找治疗有症状的子宫腺肌病的最佳医学方法。本系统评价和荟萃分析研究了口服孕激素地诺孕素治疗子宫腺肌病相关疼痛和出血的作用。2024 年 1 月检索了 Cochrane 中央对照试验注册库（CENTRAL）、EMBASE、MEDLINE、Scopus 和 Web of Science。主要结局是痛经疼痛评分，次要结局是慢性盆腔痛（CPP）、子宫体积（UV）和月经过多。对子宫腺肌病患者接受地诺孕素治疗前后的结局进行了比较。纳入研究的汇总分析报告称，地诺孕素治疗后痛经疼痛评分有统计学显著降低（10cm 视觉模拟评分上的平均差异 -5.86cm，95%CI-7.20 至-4.53，I2=97%）。关于慢性盆腔痛，纳入研究的荟萃分析显示治疗后疼痛显著下降（标准化均数差-2.37，95%CI-2.89 至-1.86，I2=60%）。然而，治疗后子宫体积无明显差异（平均差异-4.65cm，95%CI-43.22 至 33.91）。治疗后月经过多明显改善（Peto 比值比 0.07，95%CI 0.03 至 0.18）。总之，地诺孕素在短期和长期治疗中似乎能有效控制子宫腺肌病女性的疼痛症状和子宫出血。
