How to Diagnose and Treat Adenomyosis in Patients with Endometriosis

Since some years the uterus has become part of the discussion about treatment concepts in patients with peritoneal and deep infiltrating endometriosis, especially in subfertile women. Anyhow adenomyosis is still underdiagnosed and its impact on symptomatology in patients with endometriosis, on subfertility especially in young premenopausal women and on the right choice of treatment approaches is still underestimated. An age related incidence is not yet known. This might be related to the difficulties in diagnosing adenomyosis. Transvaginal ultrasound and MR imaging have a high accuracy in the hands of the skilled examiner, but the global awareness on how to diagnose adenomyosis has just begun. Pretherapeutical screening for adenomyosis allows the identification of subgroups and thus individualization of medical and surgical treatment. In the following the actual not yet evidence based diagnostic and therapeutic options, especially in patients with adenomyosis and subfertility are reviewed and discussed.