Adenomyosis – An Overview

Stephanie Wong, Wong S, Charles E. Ray, Ray CE Jr
Seminars in interventional radiology · 2022 · vol. 39(01) , pp. 119–122 · doi:10.1055/s-0042-1742345 · PMID:35210742 · PMC8856779 · W4213118568
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⚙ AI-generated summary by claude@2026-07, 2026-07-08 ⓘ

Adenomyosis, characterized by endometrial tissue in the myometrium, presents with various symptoms and is increasingly diagnosed non-invasively using imaging, necessitating proper treatment especially for women desiring fertility.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-08 · read from full text ⓘ

This article provides an overview of adenomyosis as a benign uterine condition characterized by endometrial glands and stroma within the myometrium, describing associated symptoms such as abnormal uterine bleeding, dysmenorrhea, dyspareunia, or infertility, with about one-third of women remaining asymptomatic. It explains that because symptoms overlap with other gynecologic diseases (notably including endometriosis), non-invasive diagnosis is challenging, and it reviews how clinicians increasingly use risk-factor profiles together with imaging—particularly transvaginal ultrasound and magnetic resonance imaging—to identify adenomyosis without hysterectomy. The paper notes that diagnosis rates have increased among reproductive-age women and emphasizes that conservative management is important for those wishing to maintain fertility, while highlighting the need for proper diagnosis to improve quality of life and outcomes. This paper is centrally about endometriosis and adenomyosis in the sense that it specifically addresses adenomyosis while explicitly discussing diagnostic difficulty due to frequent co-existence and symptom overlap with endometriosis.

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Abstract

Adenomyosis is a benign uterine disorder in which there is a pathological presence of endometrial glands and stroma in the myometrium. Symptoms can include abnormal uterine bleeding, dysmenorrhea, dyspareunia, or infertility; one-third of women, however, remain asymptomatic.[1] [2] Since many of these symptoms also occur in other gynecological diseases such as endometriosis and uterine fibroids, which often co-exist with adenomyosis, making a clinical diagnosis can be difficult. In the past, adenomyosis was only diagnosed on histopathology after a hysterectomy. With the combination of a patient's risk factor profile, clinical symptoms, and imaging diagnostic tools such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), clinicians are able to identify adenomyosis in a non-invasive way.[1] [3] [4] [5] The diagnosis of adenomyosis has been increasing in young women of reproductive age and conservative treatment is essential in those who prefer to maintain fertility.[1] [5] Since adenomyosis greatly impacts quality of life, it is important for clinicians to properly diagnose and treat these women to optimize clinical outcome.
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Subscribe to RSS DOI: 10.1055/s-0042-1742345 Adenomyosis – An Overview Authors Adenomyosis is a benign uterine disorder in which there is a pathological presence of endometrial glands and stroma in the myometrium. Symptoms can include abnormal uterine bleeding, dysmenorrhea, dyspareunia, or infertility; one-third of women, however, remain asymptomatic.[1] [2] Since many of these symptoms also occur in other gynecological diseases such as endometriosis and uterine fibroids, which often co-exist with adenomyosis, making a clinical diagnosis can be difficult. In the past, adenomyosis was only diagnosed on histopathology after a hysterectomy. With the combination of a patient's risk factor profile, clinical symptoms, and imaging diagnostic tools such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), clinicians are able to identify adenomyosis in a non-invasive way.[1] [3] [4] [5] The diagnosis of adenomyosis has been increasing in young women of reproductive age and conservative treatment is essential in those who prefer to maintain fertility.[1] [5] Since adenomyosis greatly impacts quality of life, it is important for clinicians to properly diagnose and treat these women to optimize clinical outcome. Publication History Article published online: 18 February 2022 © 2022. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA - References - 1 Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019 Mar 13;8:F1000 Faculty Rev-283. doi: 10.12688/f1000research.17242.1. PMID: 30918629; PMCID: PMC6419978. - 2 Yu O, Schulze-Rath R, Grafton J, Hansen K, Scholes D, Reed SD. Adenomyosis incidence, prevalence and treatment: United States population-based study 2006-2015. Am J Obstet Gynecol 2020; 223 (01) 94.e1-94.e10 - 3 Chapron C, Vannuccini S, Santulli P. et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update 2020; 26 (03) 392-411 - 4 Bae SH, Kim MD, Kim GM. et al. Uterine Artery Embolization for Adenomyosis: Percentage of Necrosis Predicts Midterm Clinical Recurrence. J Vasc Interv Radiol 2015; 26 (09) 1290-6.e2 - 5 Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y. Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy. Insights Imaging 2019; 10 (01) 48 - 6 Zhou J, He L, Liu P. et al. Outcomes in Adenomyosis Treated with Uterine Artery Embolization Are Associated with Lesion Vascularity: A Long-Term Follow-Up Study of 252 Cases. PLoS One 2016; 11 (11) e0165610 - 7 Antero MF, Ayhan A, Segars J, Shih IM. Pathology and Pathogenesis of Adenomyosis. Semin Reprod Med 2020;38(2-03):108–118 Epub2020Oct20. - 8 Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 2011; 22 (07) 901-909 , quiz 909. - 9 Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril 2018; 109 (03) 398-405 - 10 Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception 2009; 79 (03) 189-193 - 11 Ozdegirmenci O, Kayikcioglu F, Akgul MA. et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril 2011; 95 (02) 497-502 - 12 Ludwig PE, Huff TJ, Shanahan MM, Stavas JM. Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature. Br J Radiol 2020; 93 (1105): 20190551 - 13 de Bruijn AM, Ankum WM, Reekers JA. et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol 2016; 215 (06) 745.e1-745.e12 - 14 Aoki M, Tokue H, Miyazaki M, Shibuya K, Hirasawa S, Oshima K. Primary postpartum hemorrhage: outcome of uterine artery embolization. Br J Radiol 2018; 91 (1087): 20180132 - 15 Kohi MP, Spies JB. Updates on uterine artery embolization. Semin Intervent Radiol 2018; 35 (01) 48-55 - 16 Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol 2014; 25 (03) 443-447 - 17 Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol 2013; 30 (04) 354-363 - 18 Binkert CA, Hirzel FC, Gutzeit A, Zollikofer CL, Hess T. Superior hypogastric nerve block to reduce pain after uterine artery embolization: advanced technique and comparison to epidural anesthesia. Cardiovasc Intervent Radiol 2015; 38 (05) 1157-1161 - 19 Noel-Lamy M, Tan KT, Simons ME, Sniderman KW, Mironov O, Rajan DK. Intraarterial lidocaine for pain control in uterine artery embolization: a prospective, randomized study. J Vasc Interv Radiol 2017; 28 (01) 16-22 - 20 de Bruijn AM, Smink M, Lohle PNM. et al. Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2017; 28 (12) 1629-1642.e1 - 21 Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility. Acta Obstet Gynecol Scand 2017; 96 (06) 707-714 - 22 Marques ALS, Andres MP, Kho RM, Abrão MS. Is High-intensity Focused Ultrasound Effective for the Treatment of Adenomyosis? A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27 (02) 332-343 - 23 McCausland V, McCausland A. The response of adenomyosis to endometrial ablation/resection. Hum Reprod Update 1998; 4 (04) 350-359

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endometriosisadenomyosisdysmenorrheadyspareuniainfertility

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