Association of hemorrhagic shock and pulmonary embolism following the administration of dienogest in a patient diagnosed with adenomyosis

Abstract

Adenomyosis is a chronic disease associated with abnormal uterine bleeding and debilitating pain with severely reduced quality of life in many affected women. Primary strategies for its management encompass surgical interventions, hormonal therapy, or a synergistic blend of these therapeutic modalities. Dienogest (DNG), a new progestin, is primarily utilized to treat adenomyosis due to its exceptional selectivity for the progesterone receptor. In this uncommon case report, we introduce a 42-year-old woman who experienced hemorrhagic shock as a result of uterine bleeding and pulmonary embolism that occurred while a patient was undergoing dienogest therapy for uterine adenomyosis. This situation necessitated blood transfusion and introduction of drugs then an emergency hysterectomy was scheduled followed by the initiation of anticoagulation. We hypothesize that the emergence of pulmonary embolism was intimately tied to adenomyosis, and the occurrence of hemorrhagic shock was likely due to the intake of dienogest.