From the Guidelines
Uterine artery embolization (UAE) should be considered for patients presenting with symptomatic adenomyosis or concomitant adenomyosis and uterine leiomyomata, as it has shown durability in symptom control with 65% to 82% of patients experiencing long-term symptomatic relief 1. When managing uterine adenomyosis, it's essential to consider the patient's symptoms, medical history, and desire for future fertility.
- Treatment options for adenomyosis include:
- Hormonal treatments, such as combined oral contraceptives or progestin-only pills, to reduce bleeding and pain.
- GnRH agonists, like leuprolide, for severe symptoms, although their use is limited due to bone density concerns 1.
- Less invasive options, including endometrial ablation or UAE, which may not be as effective for adenomyosis as for other conditions.
- UAE has been shown to be effective in controlling symptoms of bleeding with adenomyosis, with recent studies demonstrating significant symptom relief and durability in symptom control 1.
- It's also important to note that adenomyosis can coexist with other conditions, such as endometriosis, and surgical methods for these conditions can be performed simultaneously 1.
- For women who have completed childbearing and have severe symptoms, hysterectomy provides definitive treatment.
- The choice of treatment should be individualized based on the patient's specific needs and medical history, and UAE should be considered as a viable option for patients with symptomatic adenomyosis or concomitant adenomyosis and uterine leiomyomata 1.
From the Research
Definition and Symptoms of Uterine Adenomyosis
- Uterine adenomyosis is a benign uterine condition characterized by the presence of endometrial glands and stroma in the uterine myometrium 2.
- Symptoms of adenomyosis include abnormal uterine bleeding, dysmenorrhea, and pelvic pain 3, 4, 5.
- Adenomyosis can also affect fertility and pregnancy outcomes, with an increased risk of miscarriage and obstetric complications 2.
Diagnosis of Uterine Adenomyosis
- Diagnosis of adenomyosis is often difficult and unclear, with no agreement on the definition and classification of adenomyotic lesions from both the histopathology and imaging points of view 2.
- Transvaginal ultrasound and magnetic resonance imaging are commonly used imaging techniques for diagnosing adenomyosis 2, 5.
- Clinical suspicion and confirmation with imaging studies are essential for diagnosing adenomyosis 5.
Treatment Options for Uterine Adenomyosis
- Medical treatments, such as hormonal therapies (e.g., progestins, oral contraceptives, gonadotropin-releasing hormone analogues) and non-hormonal treatments (e.g., nonsteroidal anti-inflammatory drugs), can improve symptoms of adenomyosis 3.
- Levonorgestrel-releasing intrauterine systems have shown effectiveness in reducing abnormal uterine bleeding and improving symptoms 3, 6, 5.
- Minimally invasive interventions, such as uterine artery embolization, radiofrequency ablation, and high-intensity focused ultrasound, can also be effective in reducing symptoms of adenomyosis 4.
- Hysterectomy may be considered for patients with severe symptoms that are not controlled with medical therapy 5.
Management and Clinical Outcomes
- Treatment of adenomyosis requires a lifelong management plan, as the disease has a negative impact on quality of life and fertility 2.
- Combination therapy may be more effective than monotherapy in managing adenomyosis 4.
- High-quality prospective and randomized controlled trials are needed to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for adenomyosis treatments 4, 6.