Adenomyosis: More common than you think

	Tweet

What’s the best treatment approach?

The definitive treatment for adenomyosis is hysterectomy.

Unlike fibroids, where a myomectomy is a surgical option, adenomyosis cannot be easily excised. Until a screening test exists that has acceptable sensitivity and specificity, safety profile, and cost, it appears that adenomyosis can only be accurately diagnosed and treated if a hysterectomy is simultaneously performed. Given that patients with symptoms suggestive of adenomyosis probably have other pathologies contributing to their symptoms, we suggest that treatment be targeted to the patient’s symptoms or other conditions. The physician needs to consider each patient’s individual situation, and make decisions based on what is appropriate for the woman’s age, parity, and plans for future reproduction.

IF A PATIENT IS NOT a candidate for hysterectomy, or doesn’t want one, you can attempt medical management of the symptoms. Adenomyosis is known to have both estrogen and progesterone receptors present, which is why hormone therapy has been investigated as an option. Since researchers have proposed that estrogen may be involved in the disease’s pathophysiology, suppressing the estrogenic environment improves the symptoms.

Investigators have also reported that GnRH-agonists can relieve adenomyosis. They have been shown to reduce uterine size, alleviate pelvic symptoms, and decrease the JZ on MRI. This may be a good option for women who temporarily want to delay surgery or who desire children in the future. Pregnancies have been reported after treatment cessation, in histologically confirmed cases of adeno-myosis, after treatment with a GnRH-agonist. It is likely that when depot preparations of GnRH antagonists become available that they would be more efficacious than GnRH agonists since they will not cause an initial gonadotropin flare. The downside, however, is that antagonists should not be used for more than 6 months because the subsequent hypoestrogenism can compromise bone density. The levonorgestrel-releasing intrauterine device has also been used successfully in women with adenomyosis. It has been observed to decrease uterine size, improve anemia, and relieve menorrhagia. Advantages of this is that it can be used on a long-term basis, and fertility is retained.

While adenomyosis may in fact be more common that we previously thought, its presence may not be clinically significant since it is often asymptomatic and frequently concurrent with other symptom producing conditions. As more controlled studies are done, we may be able to determine the significance of the diagnosis, if any.

DR. MASEELALL is a Fellow, Reproductive Endocrinology and Infertility, at UMDNJ-New Jersey Medical School, Newark, NJ. DR. WEISS is Professor and Chair, Department of Obstetrics, Gynecology and Women’s Health, UMDNJ-New Jersey Medical School, Newark, NJ.

REFERENCES

_{1. Lewinski H. Beitrag zur frage der adenomyosis. Zentralbl Gynaekol. 1931;55:2163-2167.}

2. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus—revisited. Am J Obstet Gynecol. 1972;112:583-593.

3. Vercellini P, Parazzini F, Oldani S, et al. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod. 1995;10:1160-1162.

4. Shaikh H, Khan KS. Adenomyosis in Pakistani women: four year experience at the Aga Khan University Medical Centre, Karachi. J Clin Pathol. 1990;43:817-819.

5. Molitor JJ. Adenomyosis: a clinical and pathological appraisal. Am J Obstet Gynecol. 1971;110:275-284.

6. Kilkku P, Erkkola R, Gronroos M. Non-specificity of symptoms related to adenomyosis. A prospective comparative survey. Acta Obstet Gynecol Scand. 1984;63:229-231.

7. Curtis KM, Hillis HD, Marchbanks PA, et al. Endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am J Obstet Gynecol. 2002;187:543-544.

8. Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol. 2000;95:688-691.

9. McElin TW, Bird CC. Adenomyosis of the uterus. Obstet Gynecol Annu. 1974;3:425-441.

10. Emge LA. The elusive adenomyosis of the uterus. Its historical past and its present state of recognition. Am J Obstet Gynecol. 1962;83:1541-1563.

11. Mathur BB, Shah BS, Bhende YM. Adenomyosis uteri. A pathologic study of 290 cases. Am J Obstet Gynecol. 1962;84:1820-1829.

12. Vercellini P, Cortesi I, De Giorgi O, et al. Transvaginal ultrasonography versus uterine needle biopsy in the diagnosis of diffuse adenomyosis. Hum Reprod. 1998;13:2884-2887.

13. Lone FW, Balogun M, Khan KS. Adenomyosis: not such an elusive diagnosis any longer. J Obstet Gynaecol. 2006;26:225-228.

14. Ascher SM, Arnold LL, Patt RH, et al. Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology. 1994;190:803-806.

15. Togashi K, Ozasa H, Konishi I, et al. Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging. Radiology. 1989;171:531-534.

16. Benson RC, Sneeden VD. Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol. 1958;76:1044-1057.

17. Grow DR, Filer RB. Treatment of adenomyosis with long-term GnRH analogues: a case report. Obstet Gynecol. 1991;78:538-539.

18. Huang FJ, Kung FT, Chang SY, et al. Effects of short-course buserelin therapy on adenomyosis. A report of two cases. J Reprod Med. 1999;44:741-744.

19. Imaoka I, Ascher SM, Sugimura K, et al. MR imaging of diffuse adenomyosis changes after GnRH analog therapy. J Magn Reson Imaging. 2002;15:285-290.

20. Fedele L, Bianchi S, Raffaelli R, et al. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68:426-429.

Publish date: Feb 1, 2008
By: Priya Maseelall, MD, Gerson Weiss, MD
source: Contemporary OB/GYN

RELATED STORIES:
The risks and benefits of the combined oral contraceptive pill   Common breast problems   How is the Vaginal Opening Affected by Childbirth – And by Episiotomy?   Premenstrual Dysphoric Disorder   Sterilization   Pelvic Inflammatory Disease (PID; Salpingitis, Endometritis)   Vaginitis   Dysmenorrhea   Rape   Menopausal Syndrome   Contraception   Infertility   Painful Intercourse (Dyspareunia)   Persistent Anovulation (Polycystic Ovary Syndrome)   Ovarian Tumors

Comments

[ + Post Your Own ]

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]