Table 4_Efficacy and safety of hormone therapies for treating adenomyosis-associated pelvic pain: a systematic review and network meta-analysis of randomized controlled trials.docx

BackgroundTo date, there are no clear guidelines available on the treatment of adenomyosis-associated pelvic pain (AAPP); however, numerous hormonal treatments (HTs) are currently being used off-label. We conducted a systematic review and network metanalysis with the aim of assessing the efficacy and safety of HTs to reduce AAPP and ranking the available options.
MethodsMEDLINE, LILACS, EMBASE, Scielo.br, PROSPERO, Cochrane Library, conference proceedings, and international registries were searched with no time, region, or language restrictions. Randomized controlled trials that analyzed AAPP in women undergoing HTs were deemed suitable.
ResultsSix studies (563 women affected by adenomyosis) were included. At 3 months, women who received a placebo or a levonorgestrel-based intrauterine system (LNG-IUS) experienced more AAPP than those who received dienogest [mean difference of visual analog scale (VAS) pain scores (MD) 4.10 (95% CI 0.49 to 7.71); high evidence; MD 3.05 (95% CI 0.45 to 5.65); high evidence]. At 6 months, women who received dienogest experienced significantly less AAPP compared to those who received combined oral contraceptives [MD -2.85 (95% CI -5.30 to -0.39); moderate evidence], while the prevalence of AAPP was higher among those who received a LNG-IUS than those who received dienogest [MD 1.79 (95% CI 0.06 to 3.53); low evidence].
ConclusionDienogest seems to be the most effective HT for AAPP. However, although rare, it is also related to more adverse effects compared to other HTs.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024535472.

背景
截至目前，子宫腺肌症相关盆腔痛（adenomyosis-associated pelvic pain, AAPP）的治疗尚无明确指南，但目前已有多种激素治疗方案（hormonal treatments, HTs）被超说明书使用。本研究开展了一项系统评价与网络荟萃分析，旨在评估各类激素治疗方案缓解AAPP的有效性与安全性，并对现有治疗方案进行排序。
方法
检索MEDLINE、LILACS、EMBASE、Scielo.br、PROSPERO、Cochrane图书馆、会议论文集及国际注册数据库，检索不受时间、地域及语言限制。纳入分析针对接受激素治疗的女性AAPP患者的随机对照试验。
结果
共纳入6项研究，涉及563例子宫腺肌症患者。治疗3个月时，接受安慰剂或左炔诺孕酮宫内缓释系统（levonorgestrel-based intrauterine system, LNG-IUS）的患者盆腔痛评分较服用地诺孕素（dienogest）者更高[视觉模拟评分法（visual analog scale, VAS）疼痛评分均数差（mean difference, MD）为4.10（95%CI：0.49~7.71），证据等级为高级；MD=3.05（95%CI：0.45~5.65），证据等级为高级]。治疗6个月时，服用地诺孕素的患者AAPP发生率显著低于复方口服避孕药使用者[MD=-2.85（95%CI：-5.30~-0.39），证据等级为中级]；而左炔诺孕酮宫内缓释系统使用者的AAPP发生率高于地诺孕素使用者[MD=1.79（95%CI：0.06~3.53），证据等级为低级]。
结论
地诺孕素或为治疗AAPP的最优激素治疗方案。不过，尽管其不良反应总体罕见，但与其他激素治疗方案相比，地诺孕素相关不良反应发生率更高。
系统评价注册
注册平台：https://www.crd.york.ac.uk/prospero/，注册编号：CRD42024535472。