title: An update on the pharmacological management of adenomyosis.
abstract: BACKGROUND
  Adenomyosis, characterized by the infiltration of the myometrium by ectopic endometrial islets, is a common condition that causes dysmenorrhea, abnormal uterine bleeding and infertility. Different treatment options exist, including medical and surgical treatments. The most commonly used medications are NSAIDs, progestogens and GnRH agonists (GnRHas).
  
  
  METHODS
  We conducted a literature search for in vitro and animal studies, randomized and non-randomized studies, systematic reviews and ongoing trials registered on ClinicalTrials.gov. There are almost no well-conducted randomized controlled trials on the pharmacological treatment of adenomyosis and the information collected from published studies is insufficient. Several therapeutic targets have been identified through animal and in vitro studies, and it is hoped that they will lead to further clinical studies on new compounds and treatment targets in this heterogeneous disease.
  
  
  CONCLUSIONS
  Hysterectomy is very effective at treating women with symptomatic adenomyosis who have completed their wish of pregnancy. For women with a future desire of pregnancy medical treatments remain the best options. Progestogens and GnRHas are the most frequently used long-term treatments for abnormal uterine bleeding and pain symptoms. In assisted reproductive techniques long agonist stimulation protocols and pretreatment with GnRHas for differed embryo transfer seem to improve pregnancy rates.
authors.affiliation: University Hospitals of Geneva and the Faculty of Medicine of the Geneva University, Departement of Gynecology and Obstetrics, Unit for Reproductive Medicine and Gynecological Endocrinology , 30, boulevard de la Cluse, Geneva, 1205 , Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Streuli
authors.forename: Jean
authors.initials: J
authors.lastname: Dubuisson
authors.forename: Pietro
authors.initials: P
authors.lastname: Santulli
authors.forename: Dominique
authors.initials: D
authors.lastname: de Ziegler
authors.forename: Frédéric
authors.initials: F
authors.lastname: Batteux
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D062788:Adenomyosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D008796:Metrorrhagia / Q000209:etiology; D017699:Pelvic Pain / Q000188:drug therapy; D011372:Progestins / Q000627:therapeutic use; D011966:Receptors, LHRH / Q000037:antagonists & inhibitors; D027724:Reproductive Techniques, Assisted
chemical_list: D020533:Angiogenesis Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D011372:Progestins; D011966:Receptors, LHRH; D007987:Gonadotropin-Releasing Hormone
keywords: abnormal uterine bleeding; adenomyosis; dysmenorrheal; hormonal treatment; infertility; medical treatment