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

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.59.53-60

Keywords:

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

Abstract

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

References

  1. Donnez, J., Donnez, O., Dolmans, M.M. “Introduction: Uterine adenomyosis, another enigmatic disease of our time.” Fertil Steril 109.3 (2018): 369–70.
  2. Seliukova, N.Y., Gladkova, A.I., Koreneva, E.M., et al. “Stress and reproductive disorders: Modern views on the problem and own research experience.” Problemi Endokrinnoi Patologii 1 (2019): 87–94.
  3. Harada, T., et al. “The Impact of Adenomyosis on Women’s Fertility.” Pediatr Emerg Care 33.12 (2017): 792–3.
  4. Zhai, J., Vannuccini, S., Petraglia, F., Giudice, L.C. “Adenomyosis: Mechanisms and Pathogenesis.” Semin Reprod Med 38.2–3 (2020): 129–43.
  5. Harmsen, M.J., Wong, C.F.C., Mijatovic, V., et al. “Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: A systematic review.” Human Reproduction Update 25 (2019): 647–71.
  6. Vannuccini, S., Tosti, C., Carmona, F., et al. “Pathogenesis of adenomyosis: an update on molecular mechanisms.” Reprod Biomed Online 35.5 (2017): 592–601. DOI: 10.1016/j.rbmo.2017.06.016
  7. Coluzzi, F., Marinangeli, F., Pergolizzi, J. “Managing chronic pain patients at the time of COVID-19 pandemic.” Minerva Anestesiologica 86 (2020): 797–9.
  8. Hron, J.D., Parsons, C.R., Williams, L.A., et al. “Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic.” Appl Clin Inform 11.3 (2020): 452–9.
  9. Shanthanna, H., Strand, N.H., Provenzano, D.A., et al. “Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel.” Anaesthesia 75 (2020): 935–44.
  10. Kemp, H.I., Corner, E., Colvin, L.A. “Chronic pain after COVID-19: implications for rehabilitation.” British Journal of Anaesthesia 125 (2020): 436–40.
  11. Cohen, S.P., Baber, Z.B., Buvanendran, A., et al. “Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises.” Pain Med (United States) 21.7 (2020): 1331–46.
  12. Emerick, T., Alter, B., Jarquin, S., et al. “Telemedicine for chronic pain in the COVID-19 era and beyond.” Pain Medicine (United States) 21 (2020): 1743–8.
  13. Hillen, F., Griffioen, A.W. “Tumour vascularization: Sprouting angiogenesis and beyond.” Cancer and Metastasis Reviews 26 (2007): 489–502.
  14. Vannuccini, S., Petraglia, F. “Recent advances in understanding and managing adenomyosis.” F1000Research 8 (2019).
  15. Yan, R., Zhang, Y., Li, Y., et al. “Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2.” Science 367.6485 (2020): 1444–8.
  16. Pons, S., Fodil, S., Azoulay, E., Zafrani, L. “The vascular endothelium: The cornerstone of organ dysfunction in severe SARS-CoV-2 infection.” Critical Care 24 (2020).
  17. Leite, A.R., Borges-Canha, M., Cardoso, R., et al. “Novel Biomarkers for Evaluation of Endothelial Dysfunction.” Angiology 71 (2020): 397–410.
  18. Kolenko, O.V., Pomytkina, N.V., Sorokin, E.L, et al. “Correlation between biochemical markers of endothelial dysfunction, free radical oxidation and morphometric parameters of macular retina in pregnant women with preeclampsia.” Vestn Oftalmol 135.2 (2019): 39–46.
  19. Vannuccini, S., Luisi, S., Tosti, C., et al. “Role of medical therapy in the management of uterine adenomyosis.” Fertility and Sterility 109 (2018): 398–405.
  20. Dessouky, R., Gamil, S.A., Nada, M.G., et al. “Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.” Insights into Imaging 10 (2019).
  21. Zhang, X., Xu, P. “Stratified treatment and management of adenomyosis.” Zhejiang Da Xue Xue Bao Yi Xue Ban 48.2 (2019): 123–9.
  22. Liang, B., Wu, L., Xu, H., et al. “Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: A comparison study in mice.” Reprod Biol Endocrinol 16.1 (2018).
  23. Sukhikh, G.T., Adamyan, L.V., Kozachenko, A.V., et al. “Dydrogesterone for the treatment of confirmed endometriosis: key results of an observational open multicenter study in real clinical practice (ORCHIDEA study).” Obstetrics and gynecology: News. Opinions. Training 4.30.8 (2020): 79–81. DOI: 10.24411/2303-9698-2020-14006
  24. Guo, S., Zhang, D., Lu, X., et al. “Hypoxia and its possible relationship with endometrial receptivity in adenomyosis: a preliminary study.” Reprod Biol Endocrinol 19.1 (2021).
  25. Higashi, Y., Noma, K., Yoshizumi, M., Kihara, Y. “Endothelial function and oxidative stress in cardiovascular diseases.” Circulation Journal 73 (2009): 411–8.
  26. Guo, S.W. “The Pathogenesis of Adenomyosis vis-à-vis Endometriosis.” J Clin Med 9.2 (2020): 485.
  27. Szefel, J., Danielak, A., Kruszewski, W.J. “Metabolic pathways of L-arginine and therapeutic consequences in tumors.” Adv Med Sci 64.1 (2019): 104–10.
  28. Engeler, D., Baranowski, A.P., Berghmans, B., et al. EAU Guidelines: Chronic Pelvic Pain. Available from: [https://uroweb.org/guideline/chronic-pelvic-pain/#5], last accessed June 25, 2021.
  29. Brainard, A.M., Korovkina, V.P., England, S.K. “Potassium channels and uterine function.” Seminars in Cell and Developmental Biology 18 (2007): 332–9.
  30. Kim, J.M., Song, K.S., Xu, B., Wang, T. “Role of potassium channels in female reproductive system.” Obstetrics and Gynecology Science 63 (2020): 565–76.
  31. Shi, J.-H., Jin, L., Leng, J.-H., Lang, J.-H. “Expression of Potassium Channels in Uterine Smooth Muscle Cells from Patients with Adenomyosis.” Chin Med J (Engl) 129.2 (2016): 200–5.
  32. Sokolova L.K. “L-arginine in norm and pathology. Tivortin.” Available from: [https://tivortin.com/en/specialistam/l-аргінін-у-нормі-та-патології/], last accessed June 25, 2021.
  33. Carrarelli, P., Luddi, A., Funghi, L., et al. “Urocortin and corticotrophin-releasing hormone receptor type 2 mRNA are highly expressed in deep infiltrating endometriotic lesions.” Reprod Biomed Online 33.4 (2016): 476–83.
  34. Carrarelli, P., Yen, C.F., Funghi, L., et al. “Expression of Inflammatory and Neurogenic Mediators in Adenomyosis.” Reprod Sci 24.3 (2017): 369–75.
  35. Zhang, X., Lu, B., Huang, X., et al. “Endometrial nerve fibers in women with endometriosis, adenomyosis, and uterine fibroids.” Fertil Steril 92.5 (2009): 1799–801.
  36. Zhang, X., Lu, B., Huang, X., et al. “Innervation of endometrium and myometrium in women with painful adenomyosis and uterine fibroids.” Fertil Steril 94.2 (2010): 730–7.
  37. Lertvikool, S., Sukprasert, M., Pansrikaew, P., et al. “Comparative Study of Nerve Fiber Density between Adenomyosis Patients with Moderate to Severe Pain and Mild Pain.” J Med Assoc Thai 97 (2014).
  38. Wang, F., Shi, X., Qin, X., et al. “Expression of CD56 in patients with adenomyosis and its correlation with dysmenorrhea.” Eur J Obstet Gynecol Reprod Biol 194 (2015): 101–5.
  39. Stratton, P., Berkley, K.J. “Chronic pelvic pain and endometriosis: Translational evidence of the relationship and implications.” Hum Reprod Update 17.3 (2011): 327–46.

Published

2021-07-22

How to Cite

Tatarchuk, T., Kalugina, L., Danylova, A., & Pavlova, K. (2021). An integrated approach to the treatment of pelvic pain associated with adenomyosis. REPRODUCTIVE ENDOCRINOLOGY, (59), 53–60. https://doi.org/10.18370/2309-4117.2021.59.53-60

Issue

Section

Tumors and pretumoral pathology