Role of Vaginal Bromocriptine in Symptomatic Management of Adenomyosis

Background: Adenomyosis is a non-malignant uterine condition causing heavy bleeding, pelvic pain, and dysmenorrhea, greatly affecting women’s lives. Although its cause is unclear, prolactin may be involved. Treatments vary, with no standard approach. Recent studies suggest that vaginal bromocriptine, a prolactin blocker, may reduce symptoms and improve quality of life. This was a retrospective, single-center study that evaluated the effectiveness and the psychosocial impact of adenomyosis. Methods: We retrospectively reviewed reproductive-aged women with adenomyosis, heavy menstrual bleeding (HMB), and dysmenorrhea, all with pictorial blood loss assessment chart (PBLAC) scores > 100, treated with 5 mg vaginal bromocriptine daily. Exclusions included pregnancy, lactation, < 6 months postpartum, fibroids, endometriosis, or prior bromocriptine use. Data collected encompassed demographics, PBLAC scores, numeric pain rating scale (NPRS) for pain assessment, and perceived stress scale (PSS) evaluations from case notes. Results: Among 52 patients (median age 39, interquartile range (IQR) 36 - 45 years), no side effects were reported with vaginal bromocriptine. The PBLAC scores dropped significantly from 235 (220 - 320) at baseline to 232 (220 - 315) at 3 months (P = 0.806), with continued decline. The NPRS scores and stress levels improved notably by 6 months. Ultrasound at 6 months showed significant improvement in vascularity (P = 0.001), junctional zone (P = 0.045), and myometrial thickening (P = 0.014) in those with lesions. Conclusion: Vaginal bromocriptine was well tolerated, with significant reductions in pain, bleeding, stress, and sonographic changes in adenomyosis. These results suggest that it could be an effective alternative treatment.