In patients with adenomyosis, HIFU combined with GnRH-a and progestin is best for pain relief, while HIFU + progestin offers reduction in uterine volume, lesion size, and recurrence rate. For heavy menstrual bleeding, HIFU + mifepristone yields the greatest benefit.
A network meta-analysis sought to investigate combination therapies for managing adenomyosis and improving patient outcomes. To ensure a robust and inclusive evaluation, researchers conducted an extensive literature search across China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Cochrane Library, Embase, PubMed, WanFang, Web of Science. In total, 31 studies were included.
The study focused on evaluating key outcomes, including visual analog scale (VAS) scores for dysmenorrhea, uterine and lesion volume measurements, menstrual blood loss, and disease recurrence rates. Both direct and indirect comparisons were quantitatively analyzed via weighted mean differences (WMD) or relative risk (RR) with corresponding 95% confidence intervals (CI), with the results visually represented in forest plots. Furthermore, the ranking probabilities were assessed to determine the likelihood of various high-intensity-focused ultrasound (HIFU) combination therapies being the most efficient for each outcome.
HIFU in conjunction with gonadotropin-releasing hormone agonist (GnRH-a) and progestin markedly reduced dysmenorrhea severity based on VAS scores. For those requiring a reduction in uterine and lesion volume, HIFU combined with progestin was the most efficient option. The same combination also proved superior in lowering recurrence rates, suggesting its potential for long-term disease control.
Meanwhile, for those struggling with excessive menstrual blood loss, HIFU combined with mifepristone emerged as the most beneficial therapy to reduce menstrual volume. Thus, depending on individual patient needs, specific HIFU-based combination therapies may provide targeted benefits. These outcomes highlight the importance of personalized approaches in adenomyosis care.
Journal of Ultrasound in Medicine
Combining Medication With High-Intensity-Focused Ultrasound for Adenomyosis A Network Meta-Analysis of Randomized Controlled Trials
Yuliang Song MM et al.
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