[Investigation of pharmacological regimens combined with focused ultrasound ablation surgery for alleviating dysmenorrhea in extrinsic adenomyosis].

Abstract

Objective: To investigate optimal long-term medication regimens combined with focused ultrasound ablation surgery (FUAS) for alleviating dysmenorrhea in patients with extrinsic adenomyosis. Methods: A retrospective research enrolled patients with extrinsic adenomyosis diagnosed by pelvic magnetic resonance imaging and presenting with significant dysmenorrhea symptoms, who underwent FUAS treatment at Qingdao Women and Children's Hospital from December 2019 to December 2023. Patients were divided into two groups based on postoperative treatment regimens: FUAS+gonadotrophin-releasing hormone agonist (GnRH-a)+levonorgestrel-releasing intrauterine system (LNG-IUS) group (Group LNG-IUS) and FUAS+GnRH-a+dienogest group (Group DNG). Clinical characteristics, imaging data, and treatment outcomes of the patients were retrospectively analyzed. Patients were followed up for 12 to 60 months to compare symptom improvement, recurrence rates, and adverse events among different treatment modalities. Results: (1) Clinical data: a total of 87 patients were included, with a mean age of (39.0±5.2) years, a median dysmenorrhea score of 8 and a median course of disease of 5 years. Group LNG-IUS comprised 53 patients with an average age of (40.2±5.2) years and a median dysmenorrhea score of 7 (including 34 cases of severe pain and 17 cases of moderate pain), among whom 24 patients (45.3%, 24/53) had deep infiltrating endometriosis (DIE). Group DNG had 34 patients with an average age of (37.1±4.5) years and a median dysmenorrhea score of 8 (including 21 cases of severe pain and 11 cases of moderate pain), among whom 25 patients (73.5%, 25/34) had DIE. (2) FUAS treatment information: in Group LNG-IUS, the average operation time was (82±29) minutes, with a median irradiation time of 570 s and an average ablation rate of (60.4±22.6)%. In Group DNG, the average operation time was (80±35) minutes, with a median irradiation time of 518 s and an average ablation rate of (58.7±17.8)%. No significant differences were observed in FUAS treatment parameters between the two groups (all P>0.05). (3) Follow-up: dysmenorrhea scores of both groups were significantly lower post treatment (all P<0.001). Different postoperative treatment regimens affected treatment outcomes (P=0.018). Long-term follow-up showed a significant difference in treatment effectiveness between the two groups (P<0.05). Uterine volume had significantly decreased in both groups compared to before treatment (all P<0.001). (4) Adverse events: adverse events during FUAS procedure were all classified as Society of Interventional Radiology (SIR) A-B, and drug-related adverse events were all grade 1-2, with no serious adverse events occurring in either group. Conclusions: Adjuvant therapy with GnRH-a and LNG-IUS or sequential dienogest after FUAS could effectively relieve dysmenorrhea in extrinsic adenomyosis patients, achieving favorable medium- and long-term therapeutic effects. The choice of medication regimen could be based on the patients' condition and personal preference. For patients with coexisting DIE, after contraindications are ruled out, sequential dienogest after FUAS combined with GnRH-a is a viable option.