Maintenance Dienogest Therapy Following Adjuvant GnRH Agonist Treatment after Uterus-Sparing Surgery in Adenomyosis

Abstract

<h3>Study Objective</h3> To investigate the safety and efficacy of combined adjuvant gonadotropin-releasing hormone agonist (GnRH-a) treatment followed by maintenance Dienogest (DNG) therapy after uterus-sparing surgery. <h3>Design</h3> A retrospective single-center observational study (Canadian Task Force classification II-2). <h3>Setting</h3> An academic tertiary hospital. <h3>Patients or Participants</h3> A total of 190 patients with severe symptomatic adenomyosis underwent uterus-sparing surgery between January 2010 and June 2020. Of these patients, 90 were eligible for this retrospective cohort study. <h3>Interventions</h3> Forty-six patients (reference group) received adjuvant 6-month GnRH-a therapy alone after uterus-sparing surgery, and 44 patients (maintenance group) received postoperative 6-month GnRH-a treatment followed by maintenance DNG therapy (2 mg per day orally). The median follow-up period was 18 months. The study was analyzed with the use of generalized estimating equations (GEE). <h3>Measurements and Main Results</h3> At baseline, the characteristics of patients in each group were comparable. Compared to the reference group, the maintenance group had a statistically significant improvement in the visual analog scale score of dysmenorrhea, hemoglobin level, and uterine volume from baseline to 18 months after uterus-sparing surgery. The symptom recurrence rate was statistically significantly lower in the maintenance group than in the reference group (4.6% vs. 37.0%, <i>P</i><0.001). <h3>Conclusion</h3> The findings of this study suggest that combined adjuvant GnRH-a treatment and maintenance DNG therapy provided a safe and an effective short-term therapy after uterus-sparing surgery for adenomyosis.