Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Alison M Zeccola, Alison Zeccola, Sarah E Allen
Current opinion in obstetrics & gynecology · 2024 · vol. 36(4) , pp. 287–295 · doi:10.1097/gco.0000000000000972 · PMID:38837727 · W4399370821
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review updates evidence for uterine-sparing interventions like UAE, RFA, HIFU, PMWA, and adenomyomectomy to treat adenomyosis, reporting symptom improvement and reduced uterine volume.

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Abstract

PURPOSE OF REVIEW: Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes. RECENT FINDINGS: Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy. SUMMARY: This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.

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Condition tags

mesh:D004412mesh:D017699adenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Uterine Artery Embolization Uterine Artery Embolization Uterine Artery Embolization Uterine Artery Embolization Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Female Female Female High-Intensity Focused Ultrasound Ablation

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.

References (73)

Cited by (3)

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License: CC0 · commercial use OK