Grand Rounds

Can GnRH Agonist be Combined with Ultrasound to Treat Adenomyosis?

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

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

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

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

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