Chronic pelvic pain with adenomyosis. Treatment methods

A.E. Esedova, A.M. Medzhidova

Dagestan State Medical University, Makhachkala

Background: the urgency of the problem concerning adenomyosis is caused not only by the severity of disease clinical manifestations but also by the diagnosis complexity at the onset stage, long-term and progressive course, persistent chronic pelvic pain, which reduces the life quality.

Aim: to increase the treatment efficacy of adenomyosis in patients with chronic pelvic pain syndrome.

Patients and Methods: a prospective comparative study was conducted with 150 female patients of reproductive age (from 24 to 38 years). 120 of them, who were treated, had primary or secondary infertility and adenomyosis, and complained of pain during periods of different severity. 30 healthy women planning pregnancy were under the follow-up (control group). Group 1 (n=60) underwent surgical treatment of adenomyosis, of which 30 women were followed up after surgery, and 30 received dienogest at a dose of 2 mg for 6 months. Group 2 (n=60) did not undergo surgery, 30 of them were under the follow-up, and the rest received dienogest at a dose of 2 mg for 6 months. The pain severity was assessed using a visual analog scale (VAS), as the size of the uterus and the uterine artery resistance index.

Results: during dienogest intake, the most significant reduction in the pain severity was achieved: 1.5 times after 3 months and almost 3 times after 6 months (p<0.05). A statistically significant (p<0.05) decrease in the uterine artery resistance index was observed only in the subgroups of patients receiving dienogest. Besides, it was found that hormonal treatment caused a decrease in the uterus size, which correlated with a  decrease in pain during periods.

Conclusion: treatment with dienogest at a dose of 2 mg may be the treatment of choice in patients with adenomyosis accompanied by severe pain syndrome.

Keywords: adenomyosis, chronic pelvic pain syndrome, dyspareunia, dienogest, dopplerometry.

For citation: Esedova A.E., Medzhidova A.M. Chronic pelvic pain with adenomyosis. Treatment methods. RMJ. 2021;4:44–47.