From the Guidelines
Hysterectomy should not be the first-line treatment for adenomyosis, and alternative treatments should be considered first due to the potential long-term risks and complications associated with hysterectomy. Adenomyosis can be an indication for hysterectomy, but it's typically considered when adenomyosis causes severe symptoms that significantly impact quality of life and when other treatments have failed, as reported in the 2024 study by the Journal of the American College of Radiology 1. These symptoms include heavy menstrual bleeding, severe pelvic pain, and cramping that don't respond to medications. For women who have completed childbearing and have debilitating symptoms, a hysterectomy provides definitive treatment as it completely removes the affected uterine tissue. However, the decision should be individualized based on symptom severity, the patient's age, desire for future fertility, and response to conservative treatments.
Some key points to consider when evaluating adenomyosis as an indication for hysterectomy include:
- The potential long-term risks and complications associated with hysterectomy, such as increased risk of cardiovascular disease, osteoporosis, and dementia, as reported in the study 1.
- The availability of alternative treatments, such as uterine artery embolization (UAE), which may provide similar symptom relief with fewer complications, as suggested by randomized studies 1.
- The importance of considering the least invasive route for hysterectomy, if it is indicated, with vaginal hysterectomy and laparoscopic hysterectomy associated with shorter operating times, faster return to normal activities, and better quality of life compared to abdominal hysterectomy 1.
Overall, while adenomyosis can be an indication for hysterectomy, it's essential to carefully weigh the potential benefits and risks and consider alternative treatments before making a decision, as emphasized in the 2024 study 1.
From the Research
Adenomyosis and Hysterectomy
- Adenomyosis is a condition where endometrial glands are found in the myometrium of the uterus, and it can cause symptoms such as heavy menstrual bleeding, pelvic pain, and infertility 2.
- Hysterectomy is a surgical option for treating adenomyosis, especially in cases where symptoms are not controlled with medical therapy 2, 3.
- However, hysterectomy may not be the first line of treatment, and other options such as hormonal menstrual suppression, levonorgestrel-releasing intrauterine systems, and surgical adenomyomectomy may be considered 4, 5.
Indications for Hysterectomy
- A study found that 42.0% of patients undergoing hysterectomy for benign diseases had histologically proven adenomyosis, with the highest rate found in patients with bleeding disorders and dysmenorrhea as indications for surgery 3.
- The study suggests that a positive anamnesis regarding symptoms such as bleeding disorders and dysmenorrhea is suspicious for adenomyosis, and hysterectomy may be considered in these cases 3.
- Another study found that patients with adenomyosis may ultimately have a hysterectomy if symptoms are not controlled with medical therapy, especially in cases where fertility is not a concern 2.
Alternative Treatment Options
- There are various treatment options available for adenomyosis, including medical options, interventional options, and surgical options, which can be tailored to symptoms and fertility desires 4, 5.
- These options include non-steroidal anti-inflammatory drugs, tranexamic acid, combined oral contraceptives, levonorgestrel intrauterine system, dienogest, other progestins, gonadotropin-releasing analogues, uterine artery embolization, endometrial ablation, and excision of adenomyosis 5.
- The choice of treatment option depends on the individual patient's symptoms, fertility desires, and overall health status 4, 5.