Levonorgestrel-Releasing Intrauterine System versus a Low-Dose Combined Oral contraceptive for Management of Adenomyosis Uteri: Randomized Clinical Trial

Abstract

Adenomyosis is a common gynecological disorder, it is a myometrial lesion characterized by the presence of ectopic endometrial glands and stroma located deep within the surrounding myometrium with adjacent myometrial hyperplasia and hypertrophy. Risk factors include increased parity, pregnancy and surgical curettage of the gravid uterus. Adenomyosis may be in: Diffuse form - the invasion of endometrial glands and/or stroma within myometrium-, or in Focal form (adenomyomata: circumscribed tumors made up of endometrium and muscle tissue). The only definitive cure for adenomyosis is a hysterectomy, however recently, new interventional techniques have been introduced over the last few years in order to find an adequate noninvasive therapy for adenomyosis. The suggestion of using LNG-IUD was based on its ability to down-regulate Estrogen Receptors (ERs) in endometrial tissues which lead to atrophy of the endometrium In addition, the LNG-IUD has a pain-relieving effect through the reduction of prostaglandin production within the endometrium and induction of adenomyosis foci atrophy. However, the suggestion of using COCs in the treatment of adenomyosis was secondary to its inhibition of prostaglandins and gonadotropin release, which decrease pain and bleeding. Long-term COC treatment can effectively reduce and delay adenomyosis, continuous regimens being better than cyclic.