TY - JOUR
T1 - Vaginal bromocriptine for treatment of adenomyosis
T2 - Impact on magnetic resonance imaging and transvaginal ultrasound
AU - Andersson, Johanna K.
AU - Pozzi Mucelli, Raffaella
AU - Epstein, Elisabeth
AU - Stewart, Elizabeth A.
AU - Gemzell-Danielsson, Kristina
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: Vaginal bromocriptine significantly reduces heavy menstrual bleeding and pain in women with diffuse adenomyosis. The aim of this pilot study was to evaluate whether imaging findings of adenomyosis, as assessed by transvaginal ultrasound (TVU) and magnetic resonance imaging (MRI) reflect changes induced by the bromocriptine treatment. Study design: Eighteen women, aged 35–50, with heavy menstrual bleeding reporting Pictorial Blood Loss Assessment Chart (PBLAC) scores >100 and diffuse adenomyosis according to both MRI and TVU were included. The subjects underwent treatment with vaginal bromocriptine for 6 months. MRI and TVU were performed at baseline and after 6 months of medication. Results: Mean age of the participants was 44.8 years, 77.8 % reported PBLAC scores > 250 and 66.7 % reported moderate to severe pain during menstruation at baseline. As compared to baseline, TVU revealed a thinner maximal Junctional Zone (JZmax) (8.5 mm [5.2−14] vs 7.9 mm [5−11.2], p = 0.02) at 6 months. Asymmetric wall thickening was seen in 13 (72 %) at baseline, and in 6 (33 %) women at 6 months, p = 0.02. No significant changes were seen in irregular endometrial-myometrial border, presence of fan-shaped shadowing, cystic changes, striations, hyperechogenic islands or lesion extension. MRI showed no significant difference in JZmax (16.0 mm[12.1−27.7] vs 15.5 mm [9.5–25.8], p = 0.81), JZdifference (9.5 mm[4.8−21.6] vs 8.4[3.8−19.5], p = 1) or Ratio JZ/myometrium (0.6 [0.5−0.8] vs. 0.6[0.4−0.8], p = 0.9) at baseline vs 6 month. Cystic lesions in the JZ were found in 9 women (50 %) before, and in 5 women (28 %) at 6 months, p = 0.13. Conclusion: TVU showed a significant decrease in JZ max and a reduced number of women with asymmetric myometrial wall thickness. The changes seen in this small pilot study may indicate that vaginal bromocriptine have an impact on adenomyosis that is reflected in radiological appearance.
AB - Objective: Vaginal bromocriptine significantly reduces heavy menstrual bleeding and pain in women with diffuse adenomyosis. The aim of this pilot study was to evaluate whether imaging findings of adenomyosis, as assessed by transvaginal ultrasound (TVU) and magnetic resonance imaging (MRI) reflect changes induced by the bromocriptine treatment. Study design: Eighteen women, aged 35–50, with heavy menstrual bleeding reporting Pictorial Blood Loss Assessment Chart (PBLAC) scores >100 and diffuse adenomyosis according to both MRI and TVU were included. The subjects underwent treatment with vaginal bromocriptine for 6 months. MRI and TVU were performed at baseline and after 6 months of medication. Results: Mean age of the participants was 44.8 years, 77.8 % reported PBLAC scores > 250 and 66.7 % reported moderate to severe pain during menstruation at baseline. As compared to baseline, TVU revealed a thinner maximal Junctional Zone (JZmax) (8.5 mm [5.2−14] vs 7.9 mm [5−11.2], p = 0.02) at 6 months. Asymmetric wall thickening was seen in 13 (72 %) at baseline, and in 6 (33 %) women at 6 months, p = 0.02. No significant changes were seen in irregular endometrial-myometrial border, presence of fan-shaped shadowing, cystic changes, striations, hyperechogenic islands or lesion extension. MRI showed no significant difference in JZmax (16.0 mm[12.1−27.7] vs 15.5 mm [9.5–25.8], p = 0.81), JZdifference (9.5 mm[4.8−21.6] vs 8.4[3.8−19.5], p = 1) or Ratio JZ/myometrium (0.6 [0.5−0.8] vs. 0.6[0.4−0.8], p = 0.9) at baseline vs 6 month. Cystic lesions in the JZ were found in 9 women (50 %) before, and in 5 women (28 %) at 6 months, p = 0.13. Conclusion: TVU showed a significant decrease in JZ max and a reduced number of women with asymmetric myometrial wall thickness. The changes seen in this small pilot study may indicate that vaginal bromocriptine have an impact on adenomyosis that is reflected in radiological appearance.
KW - Adenomyosis
KW - Bromocriptine
KW - Menstrual bleeding
KW - Prolactin
KW - Radiological imaging
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U2 - 10.1016/j.ejogrb.2020.08.040
DO - 10.1016/j.ejogrb.2020.08.040
M3 - Article
C2 - 32920421
AN - SCOPUS:85090595830
SN - 0301-2115
VL - 254
SP - 38
EP - 43
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
ER -