Adenomyosis is a chronic gynecological disorder primarily affecting women of reproductive age, with its underlying causes remaining unclear. In clinical settings, gonadotropin-releasing hormone agonists (GnRH-a), often in combination with other medications, are employed to manage mild to moderate cases. This meta-analysis aimed to assess the therapeutic effectiveness of combining dienogest with GnRH-a in treating adenomyosis and to investigate associated obstetric risk factors. A comprehensive literature search identified relevant studies published up to 2024, resulting in 5 studies encompassing 520 patients included in the meta-analysis. Findings indicated that the combination therapy significantly improved visual analogue scale scores, hemoglobin levels, CA-125 levels, and uterine volume compared to monotherapy, without increasing adverse event rates. Furthermore, analysis of 11 studies including 15,015 participants on obstetric outcomes revealed that women with adenomyosis faced higher risks of spontaneous abortion, premature rupture of membranes, preterm birth, small-for-gestational-age infants, and cesarean delivery. These results suggest that dienogest combined with GnRH-a enhances treatment outcomes in adenomyosis while emphasizing the elevated obstetric risks associated with the condition.
