title: Update on the surgical management of adenomyosis.
abstract: OBJECTIVE
  Adenomyosis is a benign gynaecological condition associated with menstrual symptoms and pelvic pain in premenopausal women, it has also been linked to subfertility. Improvement in ultrasound and MRI imaging has allowed accurate diagnosis of this condition prior to histological confirmation. Patients opting for surgical management need to be counselled regarding the surgical options available. This review summarizes the surgical management of adenomyosis and reviews the recent surgical developments.
  
  
  RESULTS
  For patients who wish to preserve their fertility, cytoreductive surgery is an option in centres with surgical expertise. Recently, modified surgical procedures to remove extensive adenomyosis known as an adenomyomectomy have been described. These operations may enhance subsequent fertility.
  
  
  CONCLUSIONS
  Access to accurate imaging modalities such as MRI and transvaginal ultrasound allows for adequate patient counselling preoperatively. Depending on the fertility requirements and the extent of adenomyosis, patients can be offered various surgical treatment options including laparoscopic hysterectomy or adenomyomectomy.
authors.affiliation: Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine and Surgery, St Bartholomew's Hospital, West Smithfield, London, UK. Litha.Pepas@bartsandthelondon.nhs.uk
authors.forename: Litha
authors.initials: L
authors.lastname: Pepas
authors.forename: Christine
authors.initials: C
authors.lastname: Deguara
authors.forename: Colin
authors.initials: C
authors.lastname: Davis
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003376:Counseling; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007246:Infertility / Q000209:etiology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010353:Patient Education as Topic; D043762:Reproductive Behavior; D055815:Young Adult