Therapeutic efficacy of dienogest combined with GnRH agonist in adenomyosis and associated obstetric risk factors: A meta-analysis

Adenomyosis is a chronic gynecological condition commonly affecting women of reproductive age, with its etiology still unclear. In clinical practice, gonadotropin-releasing hormone agonists (GnRH-a), often combined with other drugs, are used to treat mild to moderate cases. This meta-analysis aimed to evaluate the therapeutic efficacy of dienogest combined with GnRH-a in managing adenomyosis and explore related obstetric risk factors. A systematic search was conducted for relevant studies published up to 2024, with 5 studies involving 520 patients included in the meta-analysis. Results showed that compared to monotherapy, the combination of dienogest and GnRH-a significantly improved visual analogue scale scores, hemoglobin levels, CA-125 levels, and uterine volume, with no significant difference in adverse event rates. Additionally, 11 studies with 15,015 participants analyzed obstetric risk factors, revealing that women with adenomyosis had significantly higher risks of spontaneous abortion, premature rupture of membranes, preterm birth, small-for-gestational-age fetuses, and cesarean section. These findings suggest that dienogest combined with GnRH-a can improve therapeutic outcomes for adenomyosis, while also highlighting increased obstetric risks associated with the condition.