Comparison of the treatment efficacies of HIFU, HIFU combined with GnRH-a, and HIFU combined with GnRH-a and LNG-IUS for adenomyosis: A systematic review and meta-analysis

Altangerel Otgontuya; Cherng-Jye Jeng; Trong-Neng Wu; Linus T Chuang; Jenta Shen

doi:10.1016/j.tjog.2022.11.009

Comparison of the treatment efficacies of HIFU, HIFU combined with GnRH-a, and HIFU combined with GnRH-a and LNG-IUS for adenomyosis: A systematic review and meta-analysis

Taiwan J Obstet Gynecol. 2023 Mar;62(2):226-238. doi: 10.1016/j.tjog.2022.11.009.

Authors

Altangerel Otgontuya¹, Cherng-Jye Jeng², Trong-Neng Wu¹, Linus T Chuang³, Jenta Shen⁴

Affiliations

¹ Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan.
² Department of Gynecology, Taipei Show Chwan Hospital, 106 Taipei, Taiwan; Department of Obstetrics and Gynecology, Chang-Hua Show Chwan Memorial Hospital, 500009 Changhua County, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Kaohsiung Medical University, 80756 Kaohiung, Taiwan. Electronic address: jengcj@gmail.com.
³ Department of Obstetrics and Gynecology, Nuvance Health, Larner College of Medicine at University of Vermont, Danbury, CT 06810, USA.
⁴ Department of Obstetrics and Gynecology, California Pacific Medical Center and St Mary's Medical Center, San Francisco, CA 94109, USA.

PMID: 36965889
DOI: 10.1016/j.tjog.2022.11.009

Abstract

To compare the treatment efficacies of high-intensity focused ultrasound (HIFU), HIFU combined with gonadotrophin-releasing hormone agonist (GnRH-a), and HIFU combined with GnRH-a and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis. We conducted a literature search in SCIENCE DIRECT, COCHRANE LIBRARY, WILLEY ONLINE LIBRARY, PUBMED, and TAYLOR FRANCIS. A total of 471 articles identified, 12 were included in a systematic review, and 11 of them deemed quantitively eligible included in the meta-analysis. The efficacies of the three treatment regimens were assessed using the dysmenorrhea and menstrual scores at 3, 6, 12, 24 months. Of the three regimens, HIFU combined with GnRH-a and LNG-IUS provides the best outcome. On dysmenorrhea score at 6 months there was significantly different higher heterogeneity with P < 0.00001 (I² = 100% WMD 21.44 [6.34, 36.53]) with statistical significance P = 0.005. At 12 months there was significantly different higher heterogeneity P < 0.00001 (I² = 100% WMD 23.47 [6.00, 40.94]) with statistically significant P < 0.008. At 24 months there was significantly different higher heterogeneity P < 0.0005 (I² = 92% WMD 6.05 [4.81, 7.30]) with statistical significance P < 0.00001. HIFU combined with GnRH-a and LNG-IUS on menstrual score at 3 months was significantly different higher heterogeneity with P < 0.00001 (I² = 100% WMD 56.23 [16.01, 96.45]) with statistical significance P = 0.006. At 6 months there was significantly different higher heterogeneity P < 0.00001 (I² = 99% WMD 93.86 [64.15, 123.57]) with statistical significance P < 0.00001. At 12 months there was significantly different higher heterogeneity P < 0.00001 (I² = 99% WMD 97.13 [67.81, 126.46]) with statistical significance P < 0.00001 compared to treatments with only HIFU and HIFU combined with GnRH-a. HIFU combined with GnRH-a and LNG-IUS treatment is more effective than only HIFU monotherapy and HIFU combined with GnRH-a.

Keywords: Adenomyosis; Efficiency; GnRH-a; HIFU; LNG-IUS; Treatment.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adenomyosis* / surgery
Dysmenorrhea / therapy
Female
Gonadotropin-Releasing Hormone
Humans
Intrauterine Devices, Medicated*
Levonorgestrel / therapeutic use
Treatment Outcome

Substances

Levonorgestrel
Gonadotropin-Releasing Hormone