From the Guidelines
Adenomyosis should be managed with uterine artery embolization (UAE) as the preferred treatment option for patients with severe symptoms who have failed conservative measures and desire uterus-preserving therapy, as it has been shown to improve quality of life and symptom scores in up to 85% of patients at long-term follow-up 1.
Treatment Options
The treatment of adenomyosis depends on the severity of symptoms and whether future fertility is desired. For mild symptoms, the following options can be considered:
- Over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) to manage pain
- Hormonal treatments such as combined oral contraceptives, progestin-only pills, or the levonorgestrel intrauterine device (Mirena) to reduce bleeding and pain by suppressing the growth of endometrial tissue
Surgical Options
For severe cases unresponsive to medication, the following surgical options can be considered:
- Endometrial ablation (destroying the uterine lining)
- Uterine artery embolization (UAE) (cutting off blood supply to affected areas)
- Hysterectomy (complete removal of the uterus) for definitive treatment According to the most recent study 1, UAE has been shown to improve symptom scores and quality of life in patients with adenomyosis, with a success rate of up to 85% at long-term follow-up.
Diagnosis
Adenomyosis is diagnosed through imaging tests like ultrasound or MRI, and sometimes can only be confirmed after hysterectomy when the tissue is examined. The American College of Obstetricians and Gynecologists (ACOG) has developed the PALM-COEIN classification system to describe uterine bleeding abnormalities in women of reproductive age, which includes adenomyosis as a structural cause of abnormal uterine bleeding 1.
From the Research
Definition and Symptoms of Adenomyosis
- Adenomyosis is a heterogeneous gynaecologic condition with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhoea 2
- Patients can also be asymptomatic, and the condition is common in reproductive-aged women 3
- Adenomyosis is characterized by the infiltration of the myometrium by ectopic endometrial islets, causing dysmenorrhea, abnormal uterine bleeding, and infertility 4
Diagnosis of Adenomyosis
- Diagnostic options include transvaginal sonography and magnetic resonance imaging 3
- Imaging studies, such as transvaginal ultrasound and magnetic resonance imaging, can show alterations in the junctional zone, which are commonly seen in adenomyosis 2
Treatment Options for Adenomyosis
- Medical options include non-steroidal anti-inflammatory drugs (NSAIDs), tranexamic acid, combined oral contraceptives, levonorgestrel intrauterine system, dienogest, other progestins, and gonadotropin-releasing analogues 3, 5
- NSAIDs are the first choice to control pain associated with adenomyosis, and are the only choice for patients with recent fertility requirements 6
- Hormonal treatments, such as progestins, oral contraceptives, and gonadotropin-releasing hormone analogues, can effectively relieve pain and control uterine bleeding 6, 5
- Surgical options include endometrial ablation, excision of adenomyosis, and hysterectomy, which is the standard treatment for adenomyosis but does not allow for future pregnancy 2, 3
Management of Adenomyosis
- The management of adenomyosis is still controversial, and there are no specific guidelines to follow for the best management 5
- Medical treatments are effective in improving symptoms, such as pain, abnormal uterine bleeding, and infertility 5
- The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis, including sex steroid hormones aberrations, impaired apoptosis, and increased inflammation 5
- New drugs are under development for the treatment of adenomyosis, such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelets therapy 5