Overview
Adenomyosis involves the presence of ectopic endometrial tissue within the myometrium, leading to menstrual symptoms, dysmenorrhea, and potential fertility issues 1.Diagnosis
Clinical Presentation: Menstrual abnormalities, pelvic pain, and pressure symptoms 1.
Imaging Criteria: MRI and transvaginal ultrasound are crucial for diagnosis, though correlation with pathology and symptoms is needed for definitive noninvasive classification 1.
Diagnostic Imaging: MRI often shows characteristic features like diffuse uterine enlargement and thickened junctional zones 1.Management
First-Line Treatments:
- Medical Management: Hormonal therapies such as oral contraceptives, progestins, and GnRH analogs can alleviate symptoms 1.
Adjunctive Treatments:
- Uterine Artery Embolization (UAE): Effective for symptom relief in symptomatic adenomyosis, showing favorable long-term outcomes 1.
- Surgical Options: Hysterectomy remains an option for refractory cases, though UAE offers a uterus-preserving alternative 1.Special Populations
Pregnancy: Limited data; complications in pregnant women with adenomyosis warrant further investigation 2.
Infertility: Treatment outcomes for infertility in women with adenomyosis require additional research 2.Key Recommendations
Establish noninvasive imaging criteria for adenomyosis diagnosis by correlating imaging findings with pathology and clinical symptoms (Evidence: Expert opinion) 1.
Consider uterine artery embolization as a viable treatment option for symptomatic adenomyosis, offering long-term symptom improvement (Evidence: Moderate) 1.
Further research is needed on the impact of adenomyosis on pregnancy outcomes and fertility treatments (Evidence: Expert opinion) 2.References
1 Caridi TM, De la Garza-Ramos C, Brook OR, Learman LA, Opoku-Anane J, Phipps D et al.. Uterine Artery Embolization for Symptomatic Adenomyosis: Proceedings from a Society of Interventional Radiology Foundation Research Consensus Panel. Journal of vascular and interventional radiology : JVIR 2022. link
2 Minegishi T, Sugino N, Ishihara O, Kitawaki J, Harada T, Murakami T. Annual report of Reproductive Endocrinology Committee, Japan Society of Obstetrics and Gynecology, 2013. The journal of obstetrics and gynaecology research 2014. link
3 Lyon SM, Cavanagh K. Uterine artery embolisation - a treatment alternative for women with fibroids. Australian family physician 2006. link
4 Mellette SJ. A woman in medicine. From the 1940s to the 1990s. A personal saga. Virginia medical quarterly : VMQ 1998. link