BACKGROUND AND PURPOSE:

• Classic treatment for adenomyosis is hysterectomy but not necessarily appropriate for younger women
• GnRH agonist therapy (GnRH-a) and high-intensity focused ultrasound (HIFU) have both been used independently but both approaches can be associated with recurrence of lack of pain relief
• Guo et al. (BJOG, 2017) investigated the clinical efficacy of GnRH-a combined with HIFU ablation treatment for adenomyosis

METHODS:

• A non-randomized prospective study (2014-2016)
• Inclusion: Patients with adenomyosis
• Patients were assigned to either:
  • Control group: Treated with only HIFU
  • Study group: Pretreatment with three courses of GnRH-a followed with HIFU ablation on day 28 after the third injection of GnRH-a
• Primary outcomes
  • Serum levels of tumor markers and cytokines; MRI derived uterine and adenomyotic lesion volumes; menstrual blood loss and dysmenorrhea scores

RESULTS:

• There were no differences between groups prior to treatment
• The serum CA125 levels were significantly decreased in both groups after HIFU, but the serum CA125 levels in the study group were still significantly lower than among controls (p < 0.05)
• The volume of uterine and adenomyotic lesions decreased in both groups, but was more marked in the study group 3 and 6 months after treatment (p < 0.05)
• Dysmenorrhea scores and menstruation volumes were significantly decreased in both groups, but were significantly lower in the study group compared to the control group after 3 and 6 months (p< 0.05)
• There was no significant difference in adverse events between groups

CONCLUSION:

• In the HIFU pretreated with GnRH-a, at 6-month follow-up
  • Uterine volume was reduced by 21% and the adenomyotic lesion volume by 35%
  • Tumor markers/cytokines and symptoms such as dysmenorrhea were also significantly reduced
• A larger, multi-center RCT is warranted to confirm findings

Learn More – Primary Sources:

Gonadotrophin-releasing hormone agonist combined with high-intensity focused ultrasound ablation for adenomyosis: a clinical study

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