Adenomyosis and Hysteroscopy: An Up-to-Date Review

Adenomyosis is a heterogeneous and benign gynecological condition that has an important impact on women in reproductive age. Adenomyosis often remains undiagnosed before a hysterectomy. An earlier diagnosis of adenomyosis requires a comprehensive medical history and a correlation of clinical examination and imaging findings, either ultrasound or MRI. Hysteroscopy can have both diagnostic and therapeutic uses regarding adenomyosis. With the improvement of the quality of mini-hysteroscopy, the hysteroscopy can be integrated as a first-line tool for diagnosis in context of abnormal uterine bleeding, infertility, or dysmenorrhea. Also, the hysteroscopy offers the possibility to perform biopsy of endomyometrial tissue under direct vision. Conservative treatment has been introduced since imaging technology and hysteroscopy have enabled the presumptive diagnosis of uterine adenomyosis in symptomatic women who want to preserve their uterus. The treatment options are depending on the age of the patients, the willingness to conceive, the type, size, and location of the lesion involve. Hysteroscopy is less invasive than laparoscopy and laparotomy for treating adenomyotic cysts. The impact of adenomyosis on fertility and failure of implantation is still debated, and treatment of adenomyosis is still lacking in the context of infertility. The aim of this chapter is to describe the importance of the diagnosis of adenomyosis by hysteroscopy and to analyze new therapeutic strategies. Similar content being viewed by others

Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:547–55. Garcia L, Isaacson K. Adenomyosis: review of the literature. J Minim Invasive Gynecol. 2011;18:428–37. Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:511–21. Rabinovici J, Stewart EA. New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:617–36. Riggs JC, Lim EK, Liang D, Bullwinkel R. Cesarean section as a risk factor for the development of adenomyosis uteri. J Reprod Med. 2014;59(1–2):20–4. Yeniel O, Cirpan T, Ulukus M, Ozbal A, Gundem G, Ozsener S, Zekioglu O, Yilmaz H, et al. Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clin Exp Obstet Gynecol. 2006;34(3):163–7. Larsen SB, Lundorf E, Forman A, Dueholm M. Adenomyosis and junctional zone changes in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2011;157(2):206–11. Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online. 2008;17(2):244–8. Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online. 2014;28:704–13. Vercellini P, Barbara G, Buggio L, Frattaruolo MP, Somigliana E, Fedele L. Effect of patient selection on estimate of reproductive success after surgery for rectovaginal endometriosis: literature review. Reprod Biomed Online. 2012;24:389–95. Novellas S, Chassang M, Delotte J, Toullalan O, Chevallier A, Bouaziz J, et al. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. Am J Roentgenol. 2011;196:1206–13. Molinas CR, Campo R. Office hysteroscopy and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:557–67. Campo R, Van Belle Y, Rombauts L, Brosens I, Gordts S. Office mini-hysteroscopy. Hum Reprod Update. 1999;5:73–81. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2007;19(6):505–12. Dueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol. 2006;20:569–82. Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27(12):3432–9. Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009;92(6):1825–33. Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40(4):464–9. Brosens I, Puttemans P, Campo R, Gordts S, Kinkel K. Diagnosis of endometriosis: pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol. 2004;18:285–303. Exacoustos C, Luciano D, Corbett B, De Felice G, Di Feliciantonio M, Luciano A, et al. The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis. Am J Obstet Gynecol. 2013;209(3):248.e1–7. Brown HK, Stoll BS, Nicosia SV, Fiorica JV, Hambley PS, Clarke LP, et al. Uterine junctional zone: correlation between histologic findings and MR imaging. Radiology. 1991;179(2):409–13. Fusi L, Cloke B, Brosens JJ. The uterine junctional zone. Best Pract Res Clin Obstet Gynaecol. 2006;20:479–91. Bromley B, Shipp TD, Benacerraf B. Adenomyosis: sonographic findings and diagnostic accuracy. J Ultrasound Med. 2000;19(8):529. -534-536 Takeuchi M, Matsuzaki K. Adenomyosis: usual and unusual imaging manifestations, pitfalls, and problem-solving MR imaging techniques. Radiographics. 2011;31(1):99–115. Lone FW, Balogun M, Khan KS. Adenomyosis: not such an elusive diagnosis any longer. J Obstet Gynaecol. 2006;26(3):225–8. http://www.ncbi.nlm.nih.gov/pubmed/16698630 Eng CW, Tang PH, Ong CL. Hysterosalpingography: current applications. Singap Med J. 2007;18:368–74. Ota H, Igarashi S, Tanaka T. Morphometric evaluation of stromal vascularization in the endometrium in adenomyosis. Hum Reprod. 1998;13(3):715–9. Dakhly DMR, Abdel Moety GAF, Saber W, Gad Allah SH, Hashem AT, Abdel Salam LOE. Accuracy of hysteroscopic endomyometrial biopsy in diagnosis of adenomyosis. J Minim Invasive Gynecol. 2016;23(3):364–71. Darwish AM, Makhlouf AM, Youssof AA, Gadalla HA. Hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 2017;86(2):139–43. http://dx.doi.org/10.1016/S0301-2115(99)00062-7 Di Spiezio SA, Florio P, Fernandez LMS, Guerra G, Spinelli M, Di Carlo C, et al. The potential role of endometrial nerve fibers in the pathogenesis of pain during endometrial biopsy at office hysteroscopy. Reprod Sci. 2015;22(1):124–31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527421/ Protopapas A, Sotiropoulou M, Athanasiou S, Loutradis D. Endocervical atypical polypoid adenomyoma. J Minim Invasive Gynecol. 2017;23(1):130–2. http://dx.doi.org/10.1016/j.jmig.2015.08.879 Boes AS, Tousseyn T, Vandenput I, Timmerman D, Vergote I, Moerman P, et al. Pitfall in the diagnosis of endometrial cancer: case report of an endometrioid adenocarcinoma arising from uterine adenomyosis. Eur J Gynaecol Oncol. 2011;32(4):431–4. Koike N, Tsunemi T, Uekuri C, Akasaka J, Ito F, Shigemitsu A, et al. Pathogenesis and malignant transformation of adenomyosis (Review). Oncol Rep. 2013;29:861–7. Donnez J, Spada F, Squifflet J, Nisolle M. Bladder endometriosis must be considered as bladder adenomyosis. Fertil Steril. 2000;74(6):1175–81. Soriano D, Bouaziz J, Elizur S, Zolti M, Orvieto R, Seidman D, et al. Reproductive outcome is favorable after laparoscopic resection of bladder endometriosis. J Minim Invasive Gynecol. 2016;23(5):781–6. Basak S, Saha A. Adenomyosis: still largely under-diagnosed. J Obstet Gynaecol. 2009;29(6):533–5. Busca A, Parra-Herran C. The role of pathologic evaluation of endometrial ablation resections in predicting ablation failure and adenomyosis in hysterectomy. Pathol Res Pract. 2016;212(9):778–82. Maia H, Maltez A, Coelho G, Athayde C, Coutinho EM. Insertion of Mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc. 2003;10(4):512–6. Naftalin J, Hoo W, Pateman K, Mavrelos D, Foo X, Jurkovic D. Is adenomyosis associated with menorrhagia? Hum Reprod. 2014;29(3):473–9. Wang PH, Su WH, Sheu BC, Liu WM. Adenomyosis and its variance: adenomyoma and female fertility. Taiwan J Obstetr Gynecol. 2009;48:232–8. Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18:374–92. Garavaglia E, Audrey S, Annalisa I, Stefano F, Iacopo T, Laura C, et al. Adenomyosis and its impact on women fertility. Iran J Reprod Med. 2015;13:327–36. Benagiano G, Habiba M, Brosens I. The pathophysiology of uterine adenomyosis: an update. Fertil Steril. 2012;98:572–9. Campo S, Campo V, Benagiano G. Adenomyosis and infertility. Reprod Biomed Online. 2012;24:35–46. Sunkara SK, Khan KS. Adenomyosis and female fertility: a critical review of the evidence. J Obstet Gynaecol. 2012;32(2):113–6. Matalliotakis IM, Katsikis IK, Panidis DK. Adenomyosis: what is the impact on fertility? Curr Opin Obstet Gynecol. 2005;17(3):261–4. Campo S, Campo V, Benagiano G. Infertility and adenomyosis. Obstet Gynecol Int. 2012;2012:786132. 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(5):964–77. Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother. 2014;15(16):2347–60. Mijatovic V, Florijn E, Halim N, Schats R, Hompes P. Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI. Eur J Obstet Gynecol Reprod Biol. 2017;151(1):62–5. http://dx.doi.org/10.1016/j.ejogrb.2010.02.047 Benagiano G, Brosens I, Habiba M. Adenomyosis: a life-cycle approach. Reprod Biomed Online. 2015;30:220–32. Fisseha S, Smith YR, Kumetz LM, Mueller GC, Hussain H, Quint EH. Cystic myometrial lesion in the uterus of an adolescent girl. Fertil Steril. 2006;86(3):716–8. Troiano RN, Flynn SD, McCarthy S. Cystic adenomyosis of the uterus: MRI. J Magn Reson Imaging. 1998;8(6):1198–202. Habiba M, Benagiano G, Brosens I. Myometrial cystic adenomyosis. In: Marwan H, MGiuseppe B, editors. Uterine adenomyosis. New York, NY: Springer; 2015. p. 163–7. Levgur M. Therapeutic options for adenomyosis: a review. Arch Gynecol Obstet. 2007;276:1–15. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101(2):472–87. Brosens I, Gordts S, Habiba M, Benagiano G. Uterine cystic adenomyosis: a disease of younger women. J Pediatr Adolesc Gynecol. 2015;28:420–6. Örs F, Lev-Toaff AS, Bergin D. Cystic adenomyoma: transvaginal ultrasound and MRI findings. Anatol J Clin Investig. 2009;3(1):68–70. Branquinho MM, Marques AL, Leite HB, Silva IS. Juvenile cystic adenomyoma. BMJ Case Rep. 2012;2012:3–5. Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2017;79(3):189–93. http://dx.doi.org/10.1016/j.contraception.2008.11.004 Tsui KH, Lee WL, Chen CY, Sheu BC, Yen MS, Chang TC, et al. Medical treatment for adenomyosis and/or adenomyoma. Taiwan J Obstetr Gynecol. 2014;53:459–65. Gordts S, Campo R, Brosens I. Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis. Gynecol Surg. 2014;11(4):273–8. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2018 Springer International Publishing AG About this chapter Cite this chapter Bouaziz, J., Soriano, D. (2018). Adenomyosis and Hysteroscopy: An Up-to-Date Review. In: Tinelli, A., Alonso Pacheco, L., Haimovich, S. (eds) Hysteroscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-57559-9_42 Download citation DOI: https://doi.org/10.1007/978-3-319-57559-9_42 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-57558-2 Online ISBN: 978-3-319-57559-9 eBook Packages: MedicineMedicine (R0)