A novel treatment of severe dysmenorrhea due to adenomyosis: a case series of 3 infertile patients treated with dopamine agonist and in vitro fertilization-embryo transfer resulting in successful pregnancy

Abstract

Few therapies for adenomyosis are available for infertile patients with reduced ovarian reserve. Previous studies investigating dopamine agonists on endometriosis have reported a reduction of peritoneal endometriosis and nerve fiber density. The present authors hypothesized that this treatment could be applied to patients with adenomyosis. They describe three infertile patients who were treated with dopamine agonists for adenomyosis. All three patients had severe dysmenorrhea due to adenomyosis with a numerical rating scale (NRS) of 10. Patients were treated twice daily with 2.5 mg bromocriptine or twice weekly with 0.5 mg cabergoline for a duration ranging from four weeks to four months. After treatment, the NRS of dysmenorrhea was about 1~2 and all patients became pregnant via in vitro fertilization-embryo transfer. Dopamine agonist acts as neurotransmitter that binds to the D2 receptor on endothelial cells and promotes VEGFR-2 endocytosis, thereby reducing immature blood vessels, nerve fiber density, and resident macrophage of endometriosis.