From the Guidelines
For the treatment of adenomyosis, medical management or uterine artery embolization (UAE) is usually the most appropriate initial therapy for reproductive-age patients with symptomatic heavy uterine bleeding or bulk symptoms and no desire for future fertility. This approach is supported by the most recent guidelines, including the 2023 update from the American College of Radiology 1.
Key Considerations
When considering treatment options for adenomyosis, several factors must be taken into account, including:
- Symptom severity
- Reproductive goals
- Patient age
- Presence of other conditions such as uterine fibroids or endometriosis
Treatment Options
Treatment options for adenomyosis can be broadly categorized into medical management, uterine-sparing surgical options, and definitive surgical treatment like hysterectomy.
- Medical Management: This often includes hormonal treatments such as combined hormonal contraceptives, progestin-only options, or continuous oral progestins. For severe symptoms, GnRH agonists can provide temporary relief but should be used cautiously due to potential bone density concerns 1.
- Uterine Artery Embolization (UAE): UAE has shown promise in controlling symptoms of adenomyosis, especially for patients who desire uterus-preserving therapy and have failed conservative measures. Recent data suggest durability in symptom control, with significant improvement in quality of life and symptom scores 1.
- Hysterectomy: For women who have completed childbearing and suffer from severe symptoms, hysterectomy offers a definitive treatment option. It is considered the most effective way to eliminate symptoms of adenomyosis, as it removes the uterus entirely, thus addressing the root cause of the symptoms 1.
Conclusion Not Applicable - Direct Answer Only
Given the most recent evidence, the initial approach for treating adenomyosis should prioritize medical management or UAE for eligible patients, considering their symptom severity, reproductive goals, and other individual factors. This approach aims to balance the effectiveness of symptom relief with the preservation of fertility and minimization of invasive procedures, unless absolutely necessary.
From the Research
Treatment Options for Adenomyosis
- Medical therapy plays a crucial role in alleviating symptoms related to adenomyosis, such as pain and abnormal uterine bleeding 2, 3, 4
- Non-steroidal anti-inflammatory drugs (NSAIDs) are the first choice for controlling pain associated with adenomyosis, especially for patients with recent fertility requirements 2
- Hormonal treatments, including oral contraceptives, levonorgestrel-releasing intrauterine system (Mirena), and dienogest, are effective in relieving pain and controlling uterine bleeding 2, 3, 4
- Gonadotropin-releasing hormone analogues can temporarily induce regression of adenomyosis and improve symptoms, and are also used before fertility treatments to improve pregnancy chances in infertile women with adenomyosis 3, 4
Minimally Invasive Interventions
- Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are alternative treatment options that can reduce abnormal uterine bleeding and dysmenorrhea due to adenomyosis 5
- These interventions are associated with a decrease in uterine volume and low rates of symptom recurrence and reintervention 5
- Combination therapy may be more effective than monotherapy, but high-quality prospective and randomized controlled trials are needed to further delineate treatment comparisons, efficacy, safety, and ideal patient selection 5
Patient-Centered Approach
- Treatment selection should be based on patient's age, symptoms, uterine size, fertility requirements, and economical conditions 2
- Diagnostic options, such as transvaginal sonography and magnetic resonance imaging, can help guide treatment decisions 6
- Patients with adenomyosis may benefit from a multidisciplinary approach, involving obstetrician-gynaecologists, radiologists, and other healthcare professionals 6