Medical treatment for adenomyosis: long term use of progestins
Background Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are av...
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| Format: | Article |
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Taylor & Francis Group
2025-12-01
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| Series: | Gynecological Endocrinology |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/09513590.2025.2511329 |
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| author | Silvia Vannuccini Francesco La Torre Federico Toscano Anna Rosa Speciale Milo Giani Dilruba Tureli Virginia Manzi Angela Gallone Felice Petraglia |
| author_facet | Silvia Vannuccini Francesco La Torre Federico Toscano Anna Rosa Speciale Milo Giani Dilruba Tureli Virginia Manzi Angela Gallone Felice Petraglia |
| author_sort | Silvia Vannuccini |
| collection | DOAJ |
| description | Background Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are available on their long-term use in adenomyosis.Objective To evaluate the long-term efficacy of different progestins, including progestin-only pills (POP), for the management of adenomyosis-related symptoms.Methods A total of 140 patients (18-45 years) with adenomyosis were treated with progestins for at least three years. The treatment groups included dienogest (2 mg, n = 71), levonorgestrel-releasing intrauterine device (52 mg, n = 25), desogestrel (75 mcg, n = 20), and drospirenone (4 mg, n = 24). Symptoms were assessed using the Visual Analogue Scale (VAS) for pain and the Pictorial Blood Assessment Chart (PBAC) method for bleeding.Results Dienogest significantly reduced dysmenorrhea, dyspareunia, and HMB, with efficacy maintained over three years in most patients. However, after the first year 49% of patients required a switch to other treatments due to side effects or contraception need. The levonorgestrel-releasing intrauterine device also effectively managed HMB and pain, with 15% of patients switching treatment due to side effects. Both drospirenone and desogestrel improved HMB and dysmenorrhea, but desogestrel had a higher discontinuation rate due to reduced long-term efficacy. Norethisterone acetate was used as a second-line treatment in cases of intolerance or inadequate response.Conclusion Progestins are effective for the long-term management of adenomyosis symptoms. The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes. |
| format | Article |
| id | doaj-art-a1a8b1524c91470bbcefca9bc9237c4e |
| institution | Kabale University |
| issn | 0951-3590 1473-0766 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Gynecological Endocrinology |
| spelling | doaj-art-a1a8b1524c91470bbcefca9bc9237c4e2025-08-20T03:47:57ZengTaylor & Francis GroupGynecological Endocrinology0951-35901473-07662025-12-0141110.1080/09513590.2025.2511329Medical treatment for adenomyosis: long term use of progestinsSilvia Vannuccini0Francesco La Torre1Federico Toscano2Anna Rosa Speciale3Milo Giani4Dilruba Tureli5Virginia Manzi6Angela Gallone7Felice Petraglia8Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, ItalyBackground Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are available on their long-term use in adenomyosis.Objective To evaluate the long-term efficacy of different progestins, including progestin-only pills (POP), for the management of adenomyosis-related symptoms.Methods A total of 140 patients (18-45 years) with adenomyosis were treated with progestins for at least three years. The treatment groups included dienogest (2 mg, n = 71), levonorgestrel-releasing intrauterine device (52 mg, n = 25), desogestrel (75 mcg, n = 20), and drospirenone (4 mg, n = 24). Symptoms were assessed using the Visual Analogue Scale (VAS) for pain and the Pictorial Blood Assessment Chart (PBAC) method for bleeding.Results Dienogest significantly reduced dysmenorrhea, dyspareunia, and HMB, with efficacy maintained over three years in most patients. However, after the first year 49% of patients required a switch to other treatments due to side effects or contraception need. The levonorgestrel-releasing intrauterine device also effectively managed HMB and pain, with 15% of patients switching treatment due to side effects. Both drospirenone and desogestrel improved HMB and dysmenorrhea, but desogestrel had a higher discontinuation rate due to reduced long-term efficacy. Norethisterone acetate was used as a second-line treatment in cases of intolerance or inadequate response.Conclusion Progestins are effective for the long-term management of adenomyosis symptoms. The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes.https://www.tandfonline.com/doi/10.1080/09513590.2025.2511329Adenomyosisprogestinsdysmenorrheaheavy menstrual bleedinglong-term treatment |
| spellingShingle | Silvia Vannuccini Francesco La Torre Federico Toscano Anna Rosa Speciale Milo Giani Dilruba Tureli Virginia Manzi Angela Gallone Felice Petraglia Medical treatment for adenomyosis: long term use of progestins Gynecological Endocrinology Adenomyosis progestins dysmenorrhea heavy menstrual bleeding long-term treatment |
| title | Medical treatment for adenomyosis: long term use of progestins |
| title_full | Medical treatment for adenomyosis: long term use of progestins |
| title_fullStr | Medical treatment for adenomyosis: long term use of progestins |
| title_full_unstemmed | Medical treatment for adenomyosis: long term use of progestins |
| title_short | Medical treatment for adenomyosis: long term use of progestins |
| title_sort | medical treatment for adenomyosis long term use of progestins |
| topic | Adenomyosis progestins dysmenorrhea heavy menstrual bleeding long-term treatment |
| url | https://www.tandfonline.com/doi/10.1080/09513590.2025.2511329 |
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