Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Medical Integration and Practice Center, Cheeloo College of Medicine, Shandong University, Jinan, China.
Gynecol Endocrinol. 2024 Dec;40(1):2409918. doi: 10.1080/09513590.2024.2409918. Epub 2024 Oct 7.
We carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis.
115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle.
Analysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23-15.25, = .023).
The results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient's health profile to optimize therapeutic outcomes and minimize adverse effects.
ChiCTR2200059548.
本研究旨在探讨在诊断为子宫腺肌病的患者的非经期开始戈舍瑞林治疗的可能性。
纳入 115 例绝经前子宫腺肌病患者，根据初诊时的月经周期阶段分为三组：月经期、卵泡期和黄体期。每组均接受 3.6mg 皮下戈舍瑞林，每月一次，连续 3 个月。终点包括子宫体积变化、痛经数字评分量表（NRS）评分、CA125 水平、12 周治疗后血红蛋白（HGB）变化以及首次治疗周期中子宫出血的发生和持续时间。
分析表明，在月经周期中开始戈舍瑞林治疗的时间并不会显著影响其缩小子宫大小、缓解疼痛、降低 CA125 水平或改善血红蛋白浓度的效果。然而，在黄体期开始治疗的患者出现更多的子宫出血（参考：月经期，OR=4.33，95%CI 1.23-15.25， = .023）。
结果表明非经期开始戈舍瑞林治疗不劣于经期开始，但黄体期组的子宫出血率更高。因此，对于门诊子宫腺肌病患者，戈舍瑞林治疗不应仅限于月经期开始；也可以在非月经期开始，为大多数咨询都在非月经期进行的患者提供更多便利。然而，为了减少出血加重的风险，尤其是对于月经过多的贫血患者，应避免在黄体期使用戈舍瑞林。本研究强调了根据患者的健康状况个体化治疗开始的重要性，以优化治疗效果并最小化不良反应。
ChiCTR2200059548。
