Adenomyosis in Reproductive Years: Abnormal Uterine Bleeding and Pain

Abnormal uterine bleeding (AUB) and menorrhalgia are major symptoms of adenomyosis and should be managed according to their severity. These symptoms are often accompanied by infertility and recurrent pregnancy loss. The patients usually receive hormonal therapy and surgery as the treatment for moderate and severe symptoms. Progestins are the first option in hormonal treatment. The principal surgical treatment option is hysterectomy as a curative surgery. When the symptoms are too severe to continue fertility treatment for adenomyosis patients who want to conceive, adenomyomectomy is another surgical option. Here, we describe some tips to deal with adenomyosis patients with pain and AUB. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Change history 10 September 2022 Correction to:

Sugino N, Kugu K, Kitawaki J, Narahara H, Minegishi T, Murakami T. Annual report of Reproductive Endocrinology Committee, Japan Society of Obstetrics and Gynecology, 2015. J Jpn Soc Obstet Gynecol (in Japanese). 2015;67:1493–511. 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;223:94 e91–10. Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2019;25:592–632. Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, Mueller M. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42:185–206. Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29:964–77. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3–13. Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011;95:2204–8, 2208 e2201–2203 Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143:393–408. Brosens I, Gordts S, Habiba M, Benagiano G. Uterine cystic adenomyosis: a disease of younger women. J Pediatr Adolesc Gynecol. 2015;28:420–6. Kriplani A, Mahey R, Agarwal N, Bhatla N, Yadav R, Singh MK. Laparoscopic management of juvenile cystic adenomyoma: four cases. J Minim Invasive Gynecol. 2011;18:343–8. Takeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Jinushi M. Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril. 2010;94:862–8. Hashimoto A, Iriyama T, Sayama S, Nakayama T, Komatsu A, Miyauchi A, Nishii O, Nagamatsu T, Osuga Y, Fujii T. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Matern Fetal Neonatal Med. 2018;31:364–9. Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Adenomyosis and risk of preterm delivery. BJOG. 2007;114:165–9. Kim SC, Lee NK, Yun KY, Joo JK, Suh DS, Kim KH. A rapidly growing adenomyosis associated with preterm delivery and postpartum abscess formation. Taiwan J Obstet Gynecol. 2016;55:620–2. Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res. 2015;41:529–33. Razavi M, Maleki-Hajiagha A, Sepidarkish M, Rouholamin S, Almasi-Hashiani A, Rezaeinejad M. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis. Int J Gynaecol Obstet. 2019;145:149–57. Yamaguchi A, Kyozuka H, Fujimori K, Hosoya M, Yasumura S, Yokoyama T, Sato A, Hashimoto K. Risk of preterm birth, low birthweight and small-for-gestational-age infants in pregnancies with adenomyosis: a cohort study of the Japan Environment and Children's Study. Acta Obstet Gynecol Scand. 2019;98:359–64. Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Complications and outcomes of pregnant women with adenomyosis in Japan. Reprod Med Biol. 2017;16:330–6. Osuga Y, Fujimoto-Okabe H, Hagino A. Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis: a randomized, double-blind, multicenter, placebo-controlled study. Fertil Steril. 2017;108:673–8. Osuga Y, Hayashi K, Kanda S. Long-term use of dienogest for the treatment of primary and secondary dysmenorrhea. J Obstet Gynaecol Res. 2020;46:606–17. Osuga Y, Watanabe M, Hagino A. Long-term use of dienogest in the treatment of painful symptoms in adenomyosis. J Obstet Gynaecol Res. 2017;43:1441–8. Fawzy M, Mesbah Y. Comparison of dienogest versus triptorelin acetate in premenopausal women with adenomyosis: a prospective clinical trial. Arch Gynecol Obstet. 2015;292:1267–71. Abbas AM, Samy A, Atwa K, Ghoneim HM, Lotfy M, Saber Mohammed H, Abdellah AM, El Bahie AM, Aboelroose AA, El Gedawy AM, Mostafa M, Elsenity MA, Samy M, Safwat S, Abdelrahman RM, Salah El Din AS, Badran E, Abdelkader AM, Abdallah A. The role of levonorgestrel intra-uterine system in the management of adenomyosis: a systematic review and meta-analysis of prospective studies. Acta Obstet Gynecol Scand. 2020;99:571–81. Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril. 2018;109:398–405. Ozdegirmenci O, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, Akyol M. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril. 2011;95:497–502. Donnez O, Donnez J. Gonadotropin-releasing hormone antagonist (linzagolix): a new therapy for uterine adenomyosis. Fertil Steril. 2020;114:640–5. Kishi Y, Suginami H, Kuramori R, Yabuta M, Suginami R, Taniguchi F. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol. 2012;207:114 e111–7. Saito A, Hirata T, Koga K, Takamura M, Fukuda S, Neriishi K, Pastorfide G, Harada M, Hirota Y, Wada-Hiraike O, Fujii T, Osuga Y. Preoperative assessment of factors associated with difficulty in performing total laparoscopic hysterectomy. J Obstet Gynaecol Res. 2017;43:320–9. Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2018;51:119–37. Nakamura K, Nakayama K, Ishikawa M, Katagiri H, Katagiri A, Ishibashi T, Sato E, Asakawa Y, Kyo S. Efficacy of multiple microwave endometrial ablation technique for menorrhagia resulting from adenomyosis. J Obstet Gynaecol Res. 2015;41:1769–72. Cheung VY. Current status of high-intensity focused ultrasound for the management of uterine adenomyosis. Ultrasonography. 2017;36:95–102. Liang E, Brown B, Rachinsky M. A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: results in 117 women. Aust N Z J Obstet Gynaecol. 2018;58:454–9. Wang S, Meng X, Dong Y. The evaluation of uterine artery embolization as a nonsurgical treatment option for adenomyosis. Int J Gynaecol Obstet. 2016;133:202–5. Marques ALS, Andres MP, Kho RM, Abrao MS. Is high-intensity focused ultrasound effective for the treatment of adenomyosis? A systematic review and meta-analysis. J Minim Invasive Gynecol. 2020;27:332–43. Kobayashi H, Sumimoto K, Moniwa N, Imai M, Takakura K, Kuromaki T, Morioka E, Arisawa K, Terao T. Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan. Int J Gynecol Cancer. 2007;17:37–43. Yeh CC, Su FH, Tzeng CR, Muo CH, Wang WC. Women with adenomyosis are at higher risks of endometrial and thyroid cancers: a population-based historical cohort study. PLoS One. 2018;13:e0194011. Izumi Y, Yamamoto T, Matsunaga N, Ota T, Owaki Y, Shinohara K, Tsuzuki T, Suzuki K. Endometrial cancer arising from adenomyosis: case report and literature review of MRI findings. Radiol Case Rep. 2020;15:427–30. Yanase T, Kikuchi A, Sasagawa M, Honma S. Two cases of endometrial cancer arising from adenomyosis during aromatase inhibitors therapy after mastectomy. J Obstet Gynaecol. 2017;37:952–4. Marcus CC. Relationship of adenomyosis uteri to endometrial hyperplasia and endometrial carcinoma. Am J Obstet Gynecol. 1961;82:408–16. Giammalvo JT, Kaplan K. The incidence of endometriosis interna in 120 cases of carcinoma of the endometrium. Am J Obstet Gynecol. 1958;75:161–6. Inoue S, Hirota Y, Ueno T, Fukui Y, Yoshida E, Hayashi T, Kojima S, Takeyama R, Hashimoto T, Kiyono T, Ikemura M, Taguchi A, Tanaka T, Tanaka Y, Sakata S, Takeuchi K, Muraoka A, Osuka S, Saito T, Oda K, Osuga Y, Terao Y, Kawazu M, Mano H. Uterine adenomyosis is an oligoclonal disorder associated with KRAS mutations. Nat Commun. 2019;10:5785. Inoue S, Yoshida E, Fukui Y, Ueno T, Kawazu M, Takeyama R, Ikemura M, Osuga Y, Terao Y, Hirota Y, Mano H. KRAS mutations in uterine endometrium are associated with gravidity and parity. Cell Death Dis. 2020;11:347. Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R. Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril. 2010;94:715–9. Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22:94–9. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101:472–87. Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018;109:406–17. Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril. 2014;102(802–807):e801. Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Clinical outcomes of infertility treatment for women with adenomyosis in Japan. Reprod Med Biol. 2017;16:276–82. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Hirota, Y., Osuga, Y. (2022). Adenomyosis in Reproductive Years: Abnormal Uterine Bleeding and Pain. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_36 Download citation DOI: https://doi.org/10.1007/978-3-030-97236-3_36 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-97235-6 Online ISBN: 978-3-030-97236-3 eBook Packages: MedicineMedicine (R0)