title: Therapeutic options for adenomyosis: a review.
abstract: BACKGROUND
  To review the literature on various therapeutic modalities for uterine adenomyosis.
  
  
  METHODS
  Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy.
  
  
  RESULTS
  Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient's age and symptoms, desired fertility, site and extent of lesion and surgeon's skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial-myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2-3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired.
  
  
  CONCLUSIONS
  Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th street, Brooklyn, NY, USA. mlevgur@maimonidesmed.org
authors.forename: Michael
authors.initials: M
authors.lastname: Levgur
mesh_terms: D004715:Endometriosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery