Adjuvant therapy in conservative surgery for adenomyosis

Area of Science:

• Gynecology
• Surgical Oncology
• Reproductive Medicine

Background:

• Adenomyosis is a common gynecological condition.
• Uterus-sparing surgery is an option for women desiring fertility preservation.
• Disease recurrence and symptom progression are significant concerns after conservative management.

Purpose of the Study:

• To evaluate the efficacy of perioperative adjuvant therapies in preventing adenomyosis recurrence.
• To investigate the role of levonorgestrel-releasing intrauterine systems (LNG-IUS) and gonadotropin-releasing hormone agonists (GnRHa) as adjuvant treatments.
• To identify risk factors for disease recurrence after uterus-sparing surgery.

Main Methods:

• Retrospective analysis of 322 patients with adenomyosis undergoing uterus-sparing surgery.
• Kaplan-Meier method and proportional hazards models were used to assess recurrence.
• Association of perioperative LNG-IUS and/or GnRHa therapy with disease recurrence and symptom progression was analyzed.

Main Results:

• Perioperative adjuvant therapy, including GnRHa, significantly reduced disease recurrence (HR 0.44, P=0.022; HR 0.48, P=0.042).
• No recurrence was observed in patients treated with perioperative LNG-IUS.
• Increased age (>35 years) was identified as the sole risk factor for recurrence (HR 2.35, P=0.047).

Conclusions:

• Perioperative adjuvant therapy with GnRHa and/or LNG-IUS is effective in reducing adenomyosis recurrence post-uterus-sparing surgery.
• These therapies offer a promising strategy for improving outcomes in adenomyosis management.
• Older age is a significant predictor of recurrent adenomyosis.