A 40-year-old woman with adenomyosis confirmed on MRI (junctional zone 18 mm) has heavy menstrual bleeding unresponsive to LNG-IUS and tranexamic acid. She strongly desires uterine preservation. Hysterectomy is declined. Which medical therapy has the best evidence for adenomyosis-related bleeding?
- A Gonadotropin-releasing hormone agonist with add-back therapy ✓
- B Combined oral contraceptive pill
- C Selective progesterone receptor modulator (ulipristal acetate)
- D Non-steroidal anti-inflammatory drugs
Correct answer: A. Gonadotropin-releasing hormone agonist with add-back therapy
Explanation
GnRH agonist with add-back therapy is the most effective medical option for adenomyosis-related bleeding when LNG-IUS fails. It induces hypoestrogenism, reducing junctional zone thickness and bleeding. Add-back (estrogen plus progestin) prevents bone loss during prolonged use. UPA is approved for fibroids, not specifically adenomyosis, though some off-label use exists.
Reference: Endometriosis and Adenomyosis: Science and Practice, 1st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.