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Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review

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Abstract

Purpose

Medical management of adenomyosis largely revolves around symptom management, with very few drugs having received regulatory approval for the disease. However, the level of evidence supporting the use of pharmacological interventions is low, making it difficult to establish their efficacy in the treatment of adenomyosis. Hence, the aim of our systematic review is to identify the strength of evidence currently available and evaluate the effectiveness of different medical interventions in the management of adenomyosis.

Methods

The search was performed in MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov. Articles published between 1 January 2010 and 30 November 2020 were considered. Randomized controlled trials and observational studies that assessed the efficacy of medical interventions in patients with adenomyosis were included. The quality of the data was analyzed using RevMan 5.3 software.

Results

LNG-IUS (levonorgestrel intrauterine system), dienogest and gonadotropin-releasing hormone (GnRH) analogues were effective in reducing pain, uterine volume and menstrual bleeding. However, these data were largely obtained in the non-trial setting and were fraught with issues that included patient selection, short duration of therapy, small sample size, and limited long-term safety and effectiveness data.

Conclusions

Although LNG-IUS, dienogest and GnRH analogues have better evidence for effectiveness in adenomyosis, the need of the hour is to thoroughly evaluate other novel molecules for adenomyosis using well-designed randomized controlled trials.

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Acknowledgements

We would like to thank SRM Institute of Science & Technology for administrative support.

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Authors and Affiliations

  1. Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Tamil Nadu, Kattankulathur, 603 203, India

    Kiran Kumar Rathinam, Justin Jacob Abraham, Heema Preethy S, Shevaani S.A & Priyadharshini A

  2. Department of Obstetrics & Gynaecology, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Tamil Nadu, Kattankulathur, 603 203, India

    Maitrayee Sen

  3. Department of Clinical Pharmacology, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Tamil Nadu, Kattankulathur, 603 203, India

    Melvin George

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Contributions

The study was conceptualized and designed by MG, KKR and JJA. The literature search and title and abstract review were performed by JJA, KKR, SAS and HPS. MG and MS conducted the data analysis. MG, MS and AP carried out the process of abstracting and quality assessment of the included studies. All authors contributed to the writing and revision of the final manuscript. The final manuscript was read and approved by all authors.

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Rathinam, K.K., Abraham, J.J., S, H.P. et al. Evaluation of pharmacological interventions in the management of adenomyosis: a systematic review. Eur J Clin Pharmacol 78, 531–545 (2022). https://doi.org/10.1007/s00228-021-03256-0

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