First-Line Treatment for Adenomyosis: Managing Dysmenorrhea and Heavy Menstrual Bleeding
Adenomyosis commonly causes heavy menstrual bleeding and pelvic pain (dysmenorrhea). When these symptoms require medical management, a structured first-line approach guides therapy selection and helps define what a successful outcome looks like.
Clinical Goals
- Reduction in heavy menstrual bleeding
- Reduction in pelvic pain (dysmenorrhea) at 6 months
Treatment Approach
First-line management draws on both non-hormonal and hormonal options. The protocol specifies which category of therapy to prioritise depending on the dominant symptom, and which specific agents have the strongest evidence — the full selection and sequencing are in the structured regimen.
References
- Oral contraceptives, levonorgestrel-releasing intrauterine system, and dienogest should be used as first-line medical options for pain and heavy menstrual bleeding from adenomyosis (strong, moderate).
- Well-established non-hormonal options include non-steroidal anti-inflammatory drugs for management of dysmenorrhea and heavy menstrual bleeding, and tranexamic acid for heavy menstrual bleeding.
- Outcomes of interest include reduction in heavy menstrual bleeding, reduction in pelvic pain (dysmenorrhea, dyspareunia, chronic pelvic pain), and improvement in reproductive outcomes (fertility, miscarriage, adverse pregnancy outcomes).
DOI: 10.1016/j.jogc.2023.04.008
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