Medical and surgical management of adenomyosis.
Adenomyosis of the uterus is a common condition amongst women in their reproductive years. It is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The common presenting symptoms are painful and heavy periods and infertility, although many women are asymptomatic. Adenomyosis is thought to affect 1% of women and is typically diagnosed in the 4th and 5th decades of life. The aetiology is unclear, and until recently a diagnosis was made only after invasive and destructive surgery. With the advent of improved imaging of the pelvic organs, and in particular magnetic resonance imaging, the diagnosis of adenomyosis is being made more frequently. Unfortunately, because the disease has been infrequently diagnosed prior to hysterectomy, there are few well-designed studies of medical or surgical management. Management with hormonal treatment that aims to reduce the proliferation of endometrial cells is promising, but there is a paucity of well-designed studies to guide treatment. Hysterectomy or use of the levonorgestrel intrauterine system (LNG-IUS) remains the mainstay of treatment.
Department of Obstetrics and Gynaecology, National Womens' Health at Auckland, City Hospital, University of Auckland, Private Bag 92019, Auckland, New Zealand. c.farquhar@auckland.ac.nz
Cynthia
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Farquhar
Ivo
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Brosens
D047072:Aromatase Inhibitors / Q000627:therapeutic use; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000145:classification / Q000601:surgery / Q000628:therapy*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use; D014591:Uterine Diseases / Q000145:classification / Q000601:surgery / Q000628:therapy*; D014594:Uterine Neoplasms / Q000145:classification / Q000628:therapy
D047072:Aromatase Inhibitors; D003271:Contraceptive Agents, Female; D004965:Estrogen Antagonists; D007987:Gonadotropin-Releasing Hormone; D016912:Levonorgestrel; D003613:Danazol