New paradigms in the conservative surgical and interventional management of adenomyosis

F.A. Alvi, Alvi FA, Farah A Alvi, Glaser LM, Laura M Glaser, L.M. Glaser, Chaudhari A, Angela Chaudhari, Susan Tsai, Tsai S, Magdy P. Milad
Current opinion in obstetrics & gynecology · 2017 · vol. 29(4) , pp. 240–248 · doi:10.1097/gco.0000000000000371 · PMID:28665807 · W2728680258
Review OA: closed CC0 ⤵ 16 in-corpus citations
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This review examines surgical and interventional options for symptomatic adenomyosis, detailing techniques, evidence, and utility of hysteroscopic ablation, adenomyomectomy, myometrial coagulation, uterine artery ligation/embolization, and focused ultrasound, considering their impact on symptoms, fertility, and reproductive outcomes.

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Abstract

PURPOSE OF REVIEW: Adenomyosis is commonly diagnosed in women of reproductive age. Interest in conservative interventions has grown as more women desire fertility preservation or avoidance of hysterectomy. This review discusses surgical and interventional methods for treatment of symptomatic adenomyosis. The technique, evidence, and utility of each method are described. RECENT FINDINGS: Hysteroscopic ablative techniques are associated with lower morbidity than with hysterectomy but may result in an unacceptable risk of treatment failure. Surgical adenomyomectomy may provide good symptomatic improvement, especially when combined with preoperative gonadotropin-releasing hormone agonist treatment. Laparoscopic myometrial coagulation is associated with high rates of future pregnancy complications. Uterine artery ligation has limited value as an isolated approach but, coupled with other techniques, provides adequate therapeutic control. Bilateral uterine artery embolization may improve symptoms, without significantly compromising fertility. Focused ultrasonic surgical methods also show promise in alleviating symptoms without compromising reproductive outcomes. SUMMARY: A multitude of surgical and interventional options are available for young women with symptomatic adenomyosis. These treatment methods have unique associated risks and benefits, and may have varying impacts on long-term symptom control, fertility, and reproductive outcomes.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Electrocoagulation Electrocoagulation Female Female Fertility Fertility Fertility Preservation Fertility Preservation Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Humans Hysterectomy

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (82)

Cited by (17)

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License: CC0 · commercial use OK