The efficacy of medical treatment for adenomyosis after adenomyomectomy

Aims To compare the efficacy of gonadotropin‐releasing hormone agonist (GnRH‐a) and GnRH‐a + levonorgestrel‐releasing intrauterine system (LNG‐IUS) after adenomyomectomy for improved adenomyosis‐associated symptoms. Methods Overall, 193 patients with adenomyosis included in this study were categorized into three groups: adenomyomectomy (n = 57, group 1), adenomyomectomy + GnRH‐a (n = 83, group 2) and adenomyomectomy + GnRH‐a + LNG‐IUS (n = 53, group 3). Visual Analog Scale (VAS) scores and uterine volumes were determined to evaluate the severity of adenomyosis. Dysmenorrhea improvement and uterine volume were the main outcomes. Results The VAS scores of all patients reduced from 7.3 (6.0, 8.5) to 0 (0, 0.6) at the 6 months after surgery, which were significantly higher in group 1 compared to other groups (P < 0.05). In groups 1, 2 and 3, there were 14, 7 and 4 patients, respectively, who suffered dysmenorrhea recurrence. The mean recurrent‐free‐survival (RFS) was 51.6 ± 2.4, 58.0 ± 1.2 and 58.3 ± 1.0 months, respectively, which was significantly shorter in group 1 (P < 0.05). The dysmenorrhea recurrences were 26.3%, 6.1%, 5.9% in groups 1, 2 and 3, respectively, at the 36 months, which was significantly higher in group 1 (P < 0.01). Significantly decreased uterine volumes were observed in all patients from 222.2 (147.6, 350.4) to 77.0 (65.9, 94.1) mL (P < 0.05) at the 6 month after surgery. Conclusion Treatment GnRH‐a and LNG‐IUS after surgery could significantly reduce the recurrence and prolong the RFS. It seemed that the use of LNG‐IUS was beneficial for a lower recurrence in long‐term follow‐up.