Efficacy and safety of dienogest versus GnRH-a combined with dienogest therapy for adenomyosis

Abstract

Abstract Objective To investigate the efficacy and safety of dienogest((DNG) monotherapy and gonadotropin-releasing hormone agonist (GnRH-a) combined with DNG sequential treatment for adenomyosis. Methods This is a retrospective study.157 patients with symptomatic adenomyosis from the first affiliated hospital of Nanjing Medical University were enrolled in the study. 61patients treated with DNG (2mg/day) alone(Group 1). 96 patients treated with DNG (2mg/day) after 3–6 injections of GnRH-a(Group 2). Results (1) The Visual analogue scale (VAS) for dysmenorrhea, serum carbohydrate antigen (CA-125) and CA19-9 levels significantly decreased in both groups compared with pre-treatment (P < 0.05). (2) The hemoglobin (Hb) level in both groups after treatment were significantly higher than pre-treatment (P < 0.05). (3) At 15–24 months of DNG treatment, uterine volume decreased significantly in Group2 compared to pre-treatment (P < 0.05), with no significant change in Group1. (4) Group 2 showed a higher rate of amenorrhea and a lower incidence of irregular spotting and breakthrough bleeding. (5) There were no significant changes in coagulation, hepatorenal function and breast tissue before and after treatment in both groups. Conclusion Both DNG monotherapy and GnRH-a + DNG sequential therapy significantly relieved dysmenorrhea, improved anemia, and reduced CA125 and CA19-9 levels in patients with symptomatic adenomyosis, with no adverse effects on coagulation, hepatorenal function and breast tissue. The sequential therapy is superior to DNG monotherapy in reducing uterine volume and lowering CA125 levels. Sequential therapy achieved better amenorrhea rate. Diffuse lesions and lesion involvement of the endometrium were the high-risk factors of heavy breakthrough bleeding during DNG treatment.