From the Guidelines
Adenomyosis is a condition where the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus, causing the uterus to enlarge and leading to painful, heavy periods, and is typically treated with uterine artery embolization (UAE) for patients with adenomyosis and fibroids who fail conservative measures and desire uterus-preserving therapy, as evidenced by recent prospective cohort studies 1.
Definition and Symptoms
Adenomyosis is characterized by the growth of endometrial tissue into the muscular wall of the uterus, leading to symptoms such as:
- Severe menstrual cramps
- Prolonged menstrual bleeding
- Pelvic pain
- Pain during intercourse
- Infertility in some cases This condition occurs when endometrial cells invade the myometrium (uterine muscle), possibly due to trauma to the uterine lining, hormonal factors, or genetic predisposition.
Treatment Options
Treatment options for adenomyosis depend on symptom severity and may include:
- Pain medications like NSAIDs (ibuprofen, naproxen)
- Hormonal treatments such as birth control pills, progesterone-containing IUDs like Mirena, or GnRH agonists
- Surgical options like endometrial ablation, uterine artery embolization, or hysterectomy for definitive treatment UAE has been shown to improve symptom scores and quality of life in patients with adenomyosis, with a recent meta-analysis reporting short-term and long-term improvement in symptoms in 94% and 85% of patients, respectively 1.
Patient Considerations
Adenomyosis most commonly affects women in their 40s and 50s and often improves after menopause when estrogen levels decline. Patients with adenomyosis should be counseled about the potential risks and benefits of treatment options, including the possibility of hysterectomy for persistent symptoms. Successful pregnancy has been reported after UAE for adenomyosis with fibroids symptoms, but comprehensive data on fertility and pregnancy is lacking 1.
From the Research
Definition of Adenomyosis
- Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus 2
- It is a benign uterine condition affecting women at various ages with different symptoms 3
- Adenomyosis is characterized by invasion of endometrial glands and stroma within the myometrium 4
Symptoms of Adenomyosis
- Heavy menstrual bleeding is the most common symptom of adenomyosis 5, 2
- Pelvic pain, including dysmenorrhea, dyspareunia, and chronic pelvic pain, are also common symptoms 5, 6
- Infertility is another symptom associated with adenomyosis 5, 3, 2
- Some patients with adenomyosis may be asymptomatic 6, 2
Diagnosis of Adenomyosis
- Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging 5, 2
- Transvaginal sonography and magnetic resonance imaging are diagnostic options for adenomyosis 5
- Histology of hysterectomy specimens was previously used to diagnose adenomyosis, but imaging techniques have made it possible to diagnose the condition without surgery 4
Treatment Options for Adenomyosis
- Treatment options for adenomyosis include medical, interventional, and surgical options 5
- Medical options include non-steroidal anti-inflammatory drugs, tranexamic acid, combined oral contraceptives, levonorgestrel intrauterine system, and gonadotropin-releasing analogues 5, 3
- Surgical options include endometrial ablation, excision of adenomyosis, and hysterectomy 5, 6
- Hysterectomy is the only definitive management option for patients with adenomyosis 6