OBJECTIVE To compare the efficacy of a selective progesterone receptor modulator, ulipristal acetate, and a gonadotropin-releasing hormone antagonist, linzagolix, in a case of severe uterine adenomyosis. DESIGN Case report. SETTING Private clinic and infertility research unit. PATIENT One patient born in 1981 who presented because of heavy menstrual bleeding, pelvic pain, and dysmenorrhea due to diffuse and disseminated uterine adenomyosis confirmed by magnetic resonance imaging (MRI). INTERVENTION The patient received a first treatment of 5 mg UPA daily for one course of 3 months. This therapy was discontinued because MRI revealed a worsened aspect. One year later, a once-daily dose of 200 mg linzagolix administered orally was initiated for 3 months, followed by another 3-month course of 100 mg once daily. MAIN OUTCOME MEASURES Clinical symptoms and MRI aspect. RESULTS During treatment with UPA, the symptoms (pelvic pain, dysmenorrhea, bulk symptoms) worsened and MRI revealed aggravation of the adenomyotic lesions. During the 12-week course of once-daily 200 mg linzagolix, the patient remained in amenorrhea and noted a very significant improvement in symptoms. On MRI, the uterine volume had fallen from 875 cm3 to 290 cm3, and the adenomyotic lesions had significantly regressed. During the 100-mg linzagolix course (weeks 13-24), the patient reported continued alleviation of her symptoms. CONCLUSION To our knowledge, this is the first reported use of linzagolix, a new oral gonadotropin-releasing hormone antagonist that significantly reduced lesion size and improved quality of life in a patient with severe adenomyosis, who was previously nonresponsive to treatment with a selective progesterone receptor modulator, ulipristal acetate.

中文翻译：

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促性腺激素释放激素拮抗剂（linzagolix）：子宫腺肌病的新疗法

目的 比较选择性孕酮受体调节剂醋酸乌利司他和促性腺激素释放激素拮抗剂林扎戈利在严重子宫腺肌症中的疗效。设计案例报告。设置私人诊所和不孕症研究单位。患者 一名 1981 年出生的患者，因经磁共振成像 (MRI) 证实的弥漫性和播散性子宫腺肌病导致月经大量出血、盆腔疼痛和痛经就诊。干预 患者接受每日 5 毫克 UPA 的首次治疗，为期 3 个月。由于 MRI 显示病情恶化，因此停止了这种治疗。一年后，开始每天一次口服 200 毫克 linzagolix，持续 3 个月，然后是另一个 3 个月的 100 毫克每天一次的疗程。主要观察指标临床症状和MRI方面。结果 UPA 治疗期间，症状（盆腔疼痛、痛经、大块症状）恶化，MRI 显示子宫腺肌病病变加重。在每天一次 200 mg linzagolix 的 12 周疗程中，患者仍处于闭经状态，并注意到症状有非常显着的改善。MRI 显示子宫体积从 875 cm3 下降到 290 cm3，子宫腺肌病病变明显消退。在 100 毫克 linzagolix 疗程（第 13-24 周）期间，患者报告其症状持续缓解。结论 据我们所知，这是首次报道使用 linzagolix，这是一种新型口服促性腺激素释放激素拮抗剂，可显着减小重度子宫腺肌病患者的病灶大小并提高生活质量，