Progress and Prospects in graded Treatment for Adenomyosis

Wang Yan(Graduate School of Zunyi Medical University)
Xiao Yanbing(Gynecology, Zunyi Maternal and Child Health Hospital)

Abstract

Adenomyosis is a common benign gynecologic disease caused by the invasion of functionally active endometrial glands as well as mesenchyme into the myometrium. The main clinical features are excessive menstrual flow, prolonged menstrual cycles, and secondary dysmenorrhea that worsens progressively and may lead to infertility.With the increasing number of intrauterine operations, mainly in the form of abortions, in the younger age groups, the incidence of the disease has shown a yearly increase, and the patients tend to be younger.There are more treatment options for adenomyosis; however, the lack of the concept of choosing treatment based on the size of the uterine lesions makes the treatment of this disease more arbitrary.Inadequate treatment, overtreatment, and hysterectomy are widespread in clinical practice.The team has long been dedicated to researching the "graded treatment" of adenomyosis. More than ten years ago, based on the characteristic of uterine volume/lesion size dependence, i.e., the "lesion threshold" phenomenon in the treatment of adenomyosis with the intrauterine placement of Mirena, the "Three schemes of Mirena" was proposed, grounded in the concept of "graded treatment".Based on the concept of "graded treatment", we proposed the "Three schemes of Mirena" and obtained a series of research results, identifying the "lesion threshold" of Mirena in the treatment of adenomyosis.The team has provided a comprehensive set of concepts and methods for treating adenomyosis to preserve the uterus. In recent years, due to the high incidence of adenomyosis and the trend of youthfulness, as well as the background of declining birth rate and fertility protection, the team has followed the research foundation and experience of the previous study, and used Danhuang Dispelling Blood Stasis Capsule/Tablet (hereinafter referred to as Danhuang) as the basic drug, and composed the "Danhuang three scheme" by using Danhuang alone or in combination with other drugs. The "Danhuang three scheme", which is a targeted treatment for adenomyosis based on different degrees of severity, has achieved sound therapeutic effects and provided a complete set of concepts and methodologies for the "fertility protection" treatment of adenomyosis.Three schemes of Mirena and Danhuang three scheme are two treatment systems based on the concept of graded treatment by the team at different times, which makes it possible to "uterine preservation and fertility protection" in the treatment of adenomyosis.Although the concepts and measures of staging/management have been published in the literature in recent years, they are overly complex and have a hysterectomy outcome, which is contrary to the era of uterine preservation and fertility protection. This article reviews the two sets of solutions of the team and other literature on the staging/management of adenomyosis to clarify the concept of adenomyosis treatment with "staging" as a means to achieve the goal of "uterine preservation and fertility protection".

Keywords

adenomyosis; graded treatment; Three schemes of Mirena; Danhuang three scheme

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Author: Wang Yan, female, born in November 1991, from Dafang, Bijie, Guizhou Province, bachelor degree, attending physician, engaged in obstetrics and gynecology research

DOI: http://dx.doi.org/10.26549/jams.v8i2.33848