Updates on adenomyosis and fertility

Maya Shats, Shats M, M. Zajicek, Zajicek M, Michal Zajicek, Siedhoff MT, Matthew T. Siedhoff, Raanan Meyer, Meyer R
Current opinion in obstetrics & gynecology · 2025 · vol. 37(4) , pp. 198–206 · doi:10.1097/gco.0000000000001039 · PMID:40304236 · W4409964978
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-06 ⓘ

This review explores fertility-sparing interventions for adenomyosis, finding that while thermal ablation and hysteroscopic techniques show promise, long-term fertility data and complication risks like uterine rupture require further study.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-08-17 · read from full text ⓘ

This review evaluates recent advancements in managing adenomyosis, specifically focusing on fertility-sparing interventions for patients desiring future pregnancy. It highlights that while minimally invasive thermal ablation and hysteroscopic techniques show promise, there is a significant lack of long-term data regarding their efficacy and safety compared to traditional surgical options. The authors note that despite varying success rates, all current approaches carry risks such as uterine rupture and placenta accreta spectrum, necessitating careful patient selection and further large-scale studies with standardized diagnostic criteria. This paper is centrally about adenomyosis — specifically examining the impact of various treatment modalities on fertility outcomes and obstetrical complications.

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Abstract

PURPOSE OF REVIEW: Adenomyosis, characterized by ectopic endometrial tissue within the myometrium, causes chronic pelvic pain, heavy bleeding, and reduced fertility. Nowadays, diagnosis relies heavily on imaging, primarily transvaginal ultrasound, supplemented by MRI. While hysterectomy remains a definitive treatment, the rise in younger patients desiring fertility necessitates uterine-sparing approaches. This review aimed to evaluate these approaches in relation to their impact on fertility and obstetrical outcomes. RECENT FINDINGS: Research highlights the association between adenomyosis and increased risk for pregnancy loss, preterm birth, and pre-eclampsia. Minimally invasive thermal ablation therapies and hysteroscopic techniques, including adenomyomectomy, offer promising fertility-sparing options, although long-term data on fertility outcomes and potential complications like uterine rupture remain limited. Advances in laparoscopic and laparotomy-based cytoreductive surgeries are also explored, but large-scale studies comparing efficacy and safety are lacking. SUMMARY: This review examines recent advancements in understanding and managing adenomyosis, focusing on fertility-sparing interventions. Studies show varying success rates for these interventions, highlighting the need for larger, well-designed trials with standardized diagnostic criteria, to assess long-term fertility outcomes, and refine patient selection for optimal results. A consistent challenge across all approaches is the potential for uterine rupture and placenta accreta spectrum, demanding careful patient selection and close monitoring.
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Purpose of review Adenomyosis, characterized by ectopic endometrial tissue within the myometrium, causes chronic pelvic pain, heavy bleeding, and reduced fertility. Nowadays, diagnosis relies heavily on imaging, primarily transvaginal ultrasound, supplemented by MRI. While hysterectomy remains a definitive treatment, the rise in younger patients desiring fertility necessitates uterine-sparing approaches. This review aimed to evaluate these approaches in relation to their impact on fertility and obstetrical outcomes. Recent findings Research highlights the association between adenomyosis and increased risk for pregnancy loss, preterm birth, and pre-eclampsia. Minimally invasive thermal ablation therapies and hysteroscopic techniques, including adenomyomectomy, offer promising fertility-sparing options, although long-term data on fertility outcomes and potential complications like uterine rupture remain limited. Advances in laparoscopic and laparotomy-based cytoreductive surgeries are also explored, but large-scale studies comparing efficacy and safety are lacking. Summary This review examines recent advancements in understanding and managing adenomyosis, focusing on fertility-sparing interventions. Studies show varying success rates for these interventions, highlighting the need for larger, well-designed trials with standardized diagnostic criteria, to assess long-term fertility outcomes, and refine patient selection for optimal results. A consistent challenge across all approaches is the potential for uterine rupture and placenta accreta spectrum, demanding careful patient selection and close monitoring.

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Condition tags

adenomyosischronic_pelvic_pain

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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