Diagnosis and treatment of adenomyosis

Ebernella Shirin Dason, Dason ES, Shirin Dason, Chan C, Crystal Chan, Mara Sobel, Sobel M
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021 · vol. 193(7) , pp. E242 · doi:10.1503/cmaj.201607 · PMID:33593948 · PMC8034338 · W3131528860
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper defines adenomyosis as a benign gynecological disorder involving endometrial tissue within the myometrium, which causes inflammation and neuroangiogenesis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This CMAJ paper reviews what is known about diagnosing and treating adenomyosis, describing women presenting with dysmenorrhea or heavy menstrual bleeding and summarizing evidence from imaging and treatment studies. It states that transvaginal ultrasound is first-line for assessing adenomyosis and has reported sensitivity of 83.8% and specificity of 63.9%, with MRI usually not required, and that medical management controls symptoms for most women, with the levonorgestrel intrauterine system showing comparable improvement versus hysterectomy in a randomized trial at 6 months. The paper notes important caveats, including that adenomyosis can co-exist with other conditions and thus cloud presentation, and that a proportion of women are asymptomatic and do not require management, as symptoms resolve after menopause. Relevance to endometriosis: it defines adenomyosis via aberrant endometrial gland/stroma development within the myometrium and discusses overlap in clinical presentation with other gynecological conditions that can include endometriosis, though the paper’s main focus is diagnosis and treatment of adenomyosis rather than endometriosis.

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Abstract

Adenomyosis is a benign gynecological disorder characterized by aberrant development of endometrial glands and stroma within the myometrium, causing inflammation and neuroangiogenesis.[1][1],[2][2] Adenomyosis often coexists with other gynecological conditions and may cloud the clinical presentation
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Medical

Empiric therapy may be started before ultrasound results are received. The levonorgestrel intrauterine system is the most-studied treatment, with the largest randomized controlled trial ( n = 86) showing comparable improvement in hemoglobin and quality of life compared with hysterectomy at 6 months. 5 Other treatments include tranexamic acid, nonsteroidal anti-inflammatory drugs, combined hormonal contraceptives and other progestins (norethindrone acetate, medroxyprogesterone, dienogest). If initial treatment fails after 3–6 months, referral to a gynecologist is suggested, to consider other medical (i.e., gonadotropin-releasing hormone agonists), interventional or surgical options. 1 , 3 , 5

Adenomyosis

Referral to a fertility specialist is appropriate for patients presenting with subfertility or recurrent miscarriage, especially after the age of 35 years. CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

Transvaginal

All women presenting with dysmenorrhea or heavy menstrual bleeding should receive a transvaginal ultrasound to assess for adenomyosis as well as to exclude other structural causes (e.g., polyps, fibroids). Transvaginal ultrasound has a sensitivity of 83.8% and specificity of 63.9% for adenomyosis, and confirmatory testing with magnetic resonance imaging is usually not required. 2

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Female Humans Intrauterine Devices, Medicated Ultrasonography

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