An integrated approach to the treatment of pelvic pain associated with adenomyosis




adenomyosis, pelvic pain, dysmenorrhoea, COVID-19, endothelial dysfunction, nitric oxide donor, dydrogesterone, L-arginine


Dysmenorrhoea and intermenstrual pelvic pain are the most common symptoms of clinical manifestations of adenomyosis, which significantly impair the quality of women’s life. Adequate and long-term pain correction and alternative therapeutic approaches became extremely important for patients with adenomyosis during the COVID-19 pandemic.
Research objective: to examine the clinical efficacy of nitric oxide donor (L-arginine) in the complex treatment of pelvic pain syndrome associated with adenomyosis.
Materials and methods. The study included 63 women diagnosed with adenomyosis. Patients were divided into 2 groups by simple randomization: I (D) group (n = 31) received dydrogesterone 30 mg from 5 to 25 days of the menstrual cycle, II (D+T) group (n = 32) in addition to dydrogesterone received a nitric oxide donor L-arginine (Тivortin) according to the scheme. Pelvic pain was assessed before treatment with a Visual Analogue Scale and a McGill Pain Questionnaire, and an assessment of the overall pain impact on women's well-being was based on the SF-36 Health Status Survey. The effectiveness of pelvic pain therapy was assessed after the first and third months of treatment, as well as three months after the end of therapy with the above methods.
Results. Researchers achieved a therapeutic effect in the treatment of chronic pelvic pain in both study groups, but in group II (D + T) after 3 months of treatment there was a significant reduction in pelvic pain, while patients of the standard therapy group have prolonged progestogen intake. There was a further improvement in the clinical condition in group I (D) after 6 months of follow-up, as well as no recurrence of pain in group II (D + T).
Conclusions. The results of study demonstrate a significant effect of Tivortin as part of complex therapy on the rate of achievement and duration of therapeutic effect in the treatment of pelvic pain associated with adenomyosis.

Author Biographies

T.F. Tatarchuk, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”; SSI “CIMT of the NAS of Ukraine”, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, head of the Endocrine Gynecology Department;

Head of Department of Reproductive Health

L.V. Kalugina, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

MD, leading researcher, Endocrine Gynecology Department

A.О. Danylova, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

Obstetrician gynecologist, postgraduate student, Endocrine Gynecology Department

K.S. Pavlova, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

Obstetrician gynecologist, postgraduate student, Endocrine Gynecology Department


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Tumors and pretumoral pathology