The challenge of adenomyosis—Surgical, endocrine and reproductive medicine treatment options

Abstract

Adenomyosis is characterized by the presence of endometrial cells in the myometrium. The clinical symptoms include pain, bleeding disorders and impaired fertility. The assessment involves a detailed anamnesis, imaging diagnostics with transvaginal ultrasonography (TVUS) and, if necessary, magnetic resonance imaging (MRI). In TVUS adenomyosis typically shows a partial disruption of the junctional zone. The treatment is holistic and includes a good pain management. For young women endocrine treatment should be carried out. Fertility therapy should be initiated with a 3-month downregulation with gonadotropin-releasing hormone (GnRH) analogues. If in vitro fertilization is necessary, treatment protocols with ultralong downregulation or delayed embryo transfer after GnRH analogues have shown better results. In advanced disease, completed family planning or treatment resistance, surgical repair and hysterectomy are also possible treatment options.