Evaluation On The Efficacy Of Different Low-dose Mifepristone Treatment For Uterine Adenomyosis Patients With Dysmenorrhea

BackgroundUterine adenomyosis is a common benign gynecologic disease, which usually accompanies with dysmenorrhea as the main symptom. At present, there is no preferred medicine for symptoms treatment and long-term management, and therefore, it is an urgent task in clinical gynecology to choose appropriate drugs for long-term effective treatments of uterine adenomyosis. In short-term treatment, mifepristone (RU486) can significantly reduce endometriosis lesions and can effectively alleviate the pain of endometriosis symptoms. Moreover, many domestic literatures reported that RU486 can improve the symptoms of uterine adenomyosis obviously and few side effects have ever been reported. In this study, in order to choose the appropriate dosage, we compared the efficacy of three different doses of RU486 on the treatment of adenomyosis. Furthermore, we evaluated its safety and provided scientific basis of adopting low dose RU486 in long-term gynecological clinical treatment of uterine adenomyosis.ObjectivesThe objectives of this study were:(1) to evaluate the efficacy of different low-dose mifepristone treatment for uterine adenomyosis patients with dysmenorrheal; (2) to choose the most reasonable treatment scheme.MethodsFrom January 2015 to January 2016 in Women’s Hospital, School of Medicine, Zhejiang University, outpatients who have been treated with vaginal three-dimensional ultrasound and/or diagnosed as diffusion adenomyosis with dysmenorrhea before therapy by MRI imaging were recruited. They were given mifepristone 25 mg/week (group I, n= 34),5 mg/day of mifepristone (II group, n= 22) and 2.5 mg/day of mifepristone (III group, n= 10) different treatments. Their VAS pain score, hypermenorrhea, uterine size, serum CA125, hemoglobin, reproductive hormones and endometrial thickness were comparatively evaluated before and after drug therapy.ResultsBoth VAS scores and hypermenorrhea of three groups of patients were significantly decreased after 3 months’treatment (p< 0.001) when compared with those before treatment. The total effective rate of improving dysmenorrhea in Group I, II and HI patients were 97.1%(33/34),100%(22/22) and 90%(9/10), respectively. But no significant differences of either the uterine size or the endometrial thickness of three groups’patients were ever observed before and after 3 months’treatment (p> 0.05). After 3 months’treatment, contents of hemoglobin in patients from Group II were significantly higher compared with before treatment (p< 0.05). However in Group I and Group III, no significant differences of the contents of patients’hemoglobin were detected before and after 3 months’treatment (p> 0.05). Level of serum CA125 in group I and II patients decreased significantly (p< 0.05) after 3 months’treatment, but no significant difference of serum CA125 level was observed in group III patients before and after 3 months (p> 0.05). There were no significant differences of LH, FSH, E2 and P value in three groups of patients before and after 3 months’treatment (p> 0.05); likewise, there was no significant difference of the change of above-mentioned four indicators between three groups (p> 0.05).ConclusionsAdoption of low doses of mifepristone can be effective treatment for uterine adenomyosis patients with dysmenorrhea, and furthermore,5 mg daily mifepristone scheme can make significant reduction of uterine volume, which can be chosen as the long-term choice for the treatment of adenomyosiss with dysmenorrhea.