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Direct and indirect imaging features of adenomyosis on ultrasound. a Small posterior wall myometrial cysts (open arrows). b Poorly defined endo-myometrial interface (solid arrow). c Diffuse myometrial heterogeneity with hyperechoic linear striations (three arrows). d Diffuse asymmetric widening of the posterior myometrial wall with hyperechoic nodules (four arrows)
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Abstract Adenomyosis is a challenging clinical condition that is commonly being diagnosed in women of reproductive age. To date, many aspects of the disease have not been fully understood, making management increasingly difficult. Over time, minimally invasive diagnostic and treatment methods have developed as more women desire uterine preservation...
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Context 1
... ultrasound (TVS) represents a cost-effective initial screening modality for adenomyosis. Ultrasound features of adenomyosis can be divided into direct or indirect features (Fig. 1). Direct features are due to the presence of endometrial tissue within the myometrium, and indirect features are due to a hypertrophied myometrium as described by Atri et al. [38]. Table 1 describes ultrasound features of adenomyosis as described in previous literature [14,16,[38][39][40][41][42][43]. To report the diagnostic accuracy ...
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Patients with endometriosis and adenomyosis naturally improve after menopause. Therefore, some patients only need to relieve symptoms, especially those near menopause, and they prefer to be treated by conservative methods. We summarized several minimally invasive interventional methods: uterine artery intervention (Uterine artery embolization, UAE)...
Purpose of Review
This article aims to offer a comprehensive review about current and investigational adenomyosis therapies and to address the gaps in our knowledge about the underlying pathogenic mechanisms to aid in the evolution of novel drugs.
Recent Findings
Despite the growing tendency to explore new drugs which target the underlying pathoph...
Citations
... Epidemiological studies indicate that chronic pelvic pain is diagnosed in 15-20% of women of reproductive age [4][5][6]. Adenomyosis is often combined with endometriosis and is a similar disease [7,8]. It is characterized by infiltration of endometrial tissue into the uterine myometrium [9]. ...
The objective: to study the impact of adenomyosis on the psychosomatic status of women of reproductive age.Materials and methods. A complex clinical-laboratory and instrumental prospective examination for women with adenomyosis was conducted in 224 patients aged 30 to 50 years (average age – 42.0±1.8 years). These patients were included in the main group of the study. The patients of the main group were divided into two subgroups depending on the form of adenomyosis: Group I – diffuse form – 106 women, Group II – nodular form – 118 women.The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.To assess the psychosomatic status of patients with adenomyosis we used the Aleksandrowicz method: a questionnaire of neurotic disorders – symptomatic (QND- S).Results. The conducted studies established that the largest number of patients were 36–40 years old – 92 (41.1±3.3%) women in the main group, and 37 (44.0±5.4%) women in the control group. A total of 152 (67.9±3.1%) patients of the main group were of reproductive age, 72 (32.1±3.1%) patients were of perimenopausal age.In patients with adenomyosis disorder of the menstrual cycle in the form of hyperpolymenorrhea was found in almost every third patient, and algomenorrhea – in almost every second person. The diagnosis was established for the first time in 8.49±2.7% of patients in Group I (9 women) and 3.38±1.8% in Group II (4 women).Less than 5 years of the disease was observed in 34.91±4.6% of patients of the Group I (37 women) and in 51.69±4.6% of the Group II (61 women). From 5 to 10 years, the disease was observed in 56.60±4.8% of patients of the Group I (60 women) and in 44.93±4.6% of the Group II (53 women). Affective stress (up to 15.50%), sleep disorders (up to 20.22%), anxiety-phobic disorders (up to 11.18%) were determined most often.Conclusions. In the vast majority of patients of reproductive age who have adenomyosis with pain syndrome, the personal characteristics are dominated by symptoms such as anxiety-phobic and depressive disorders, affective tension, sexual, obsessive and anankastic disorders.
... Characteristic symptoms of adenomyosis are menorrhagia, dysmenorrhea, uterine enlargement and infertility [8,9]. The prevalence rate of adenomyosis ranges from 5% to 70%, depending on differences in ethnicity, case selection, and diagnostic criteria [10][11][12][13]. To improve the quality of life of patients, various therapeutic approaches are widely used, such as conservative treatment, surgery, hormonal therapy and interventional radiology or minimally invasive therapy [14][15][16]. ...
The objective: to assess the composition of the vaginal microbiota in women of reproductive age with adenomyosis.Materials and methods. A comprehensive clinical-laboratory and instrumental prospective examination of 224 patients aged 30 to 50 years (average age – 42.0±1.8 years) with adenomyosis, who were included in the main study group, was conducted. The patients of the main group were divided into 2 subgroups depending on the form of adenomyosis – I group (diffuse form) included 106 women, II group (nodular form) – 118 persons. The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.Patients underwent microscopic examination of vaginal secretions, bacterioscopic examination of vaginal smears, stained according to Gram. Lactobacillus cultures were identified by polymerase chain reaction (PCR) and 16S ribosomal ribonucleic acid analysis. Results. During the microscopic examination of the vaginal secretion, more than 15 leukocytes in the field of view were detected in 84 (37.5±3.2%) patients of both groups: in 40 (47.9±3.3%) patients of the I group and in 44 (52.1±3.3%) – II group. During the bacterioscopic examination of vaginal swabs, stained according to Gram, no gonococci and trichomonads were found in the main group. Candida fungi were detected microscopically in 158 patients (70.5±3.1%) of the main group: in 71 (66.9±4.6%) of the I group and in 87 (33.1±4.3%) of II group.Genotyping results showed that lactobacilli isolated from women with adenomyosis belonged to seven species: Lactobacillus fermentum, Lactobacillus iners, Lactobacillus gasseri, Lactobacillus amnionii, Lactobacillus jensenii, Lactobacillus crispatus, and Lactobacillus delbrueskii. The majority of lactobacilli strains have high inhibitory activity against all test strains, except for Candida albicans (39 cases, 46.4%). High adhesion to human erythrocytes was determined by 54.7% (46 cases) of the studied cultures.All lactobacilli strains were resistant to metronidazole, 83.3% (70 cases) to kanamycin, 57.1% (48 cases) to vancomycin, all strains were sensitive to roxithromycin, amoxiclav, and ampicillin. Moderate sensitivity to gentamicin and cefazolin was found in 51.9% (43 cases) of cultures, peroxide-forming activity in 80.9% (68 cases).The use of quantitative diagnostic thresholds has led to significant improvements in diagnostic performance. PCR showed 88% sensitivity and 95% specificity for Gardnerella vaginalis and 96% sensitivity and 97% specificity for Atopobium vaginae.Conclusions. It has been established that bacterial vaginosis and microorganisms associated with bacterial vaginosis are independently associated with adenomyosis. The results of the study confirmed that vaginal microorganisms, which are usually diagnosed in women with adenomyosis, ascend to the endometrium from the vagina vertically, which leads to infection of the upper parts of the genital tract.
... Adenomyosis is a gynecological benign lesion caused by the invasion of endometrium and stroma into normal myometrium, which is more common in women of childbearing age. It is characterized by enlarged uterus, excessive menstruation, and dysmenorrhea, which can affect women's fertility [1,2]. The prevalence rate of adenomyosis in infertile women under the age of 40 is about 20.0%, rising to 29.7% over the age of 40, and as high as 30% to 40% among women who use assisted reproductive technology [3]. ...
... Clinical symptoms of adenomyosis are menorrhagia, pelvic pain, and dysmenorrhea; and risk factors associated are spontaneous and induced abortions, multiparity, endometrial hyperplasia, endometriosis, smoking, and surgical trauma [5,6]. Current treatment options for symptomatic adenomyosis include hysterectomy, medication, conservative surgery, or minimally invasive techniques including uterine artery embolization [7,8]. We present three case reports of extrauterine adenomyoma (recto-vaginal/retro-cervical space, broad ligament, and large abdominal) managed by laparoscopic excision. ...
Introduction: We present three case reports of extrauterine adenomyoma (recto-vaginal/retro-cervical, broad ligament, abdominal). The common presenting symptoms in our patients were pelvic pain, dysmenorrhea, and deep dyspareunia. The cases were successfully treated with laparoscopic excision by a multidisciplinary team of doctors. One patient showed adenomyoma co-existing with endometriosis on histopathological examination of the tissue sample. Case Series: We present 3 cases of extra uterine adenomyomas in 3 different sites, each case representing a different theory of origin and all cases managed laparoscopically with successful outcome without any complications. First case represent the implantation theory following antecedent myomectomy. Second case represents origin of adenomyoma as direct extension from the uterus with background of severe diffuse adenomyosis. Third case represents origin from Müllerian remnants in the recto-vaginal septum with no adenomyosis or obliteration of the pouch Douglas. Conclusion: We propose the theory that adenomyoma which is a form of adenomyosis should be regarded as a form of deep endometriosis involving the uterus rather than a separate entity. We believe that multidisciplinary laparoscopic treatment is the way forward for accurate diagnosis and treatment of adenomyosis in patients requiring to preserve fertility. Future research needs to focus on studying endometriosis behavior and recurrence according to the tissue host to understand the disease and tailor the management according to patient symptoms.
... Hyperthermic ablation involves the application of thermal energy to abnormal tissue, causing the intracellular temperature to rise to the point where cellular death occurs. 21,22 There are three energy sources that may be used for hyperthermic ablation: radiofrequency, microwave, and HIFU. 23 Radiofrequency ablation (RFA) uses probes tipped with electrodes that deliver high-frequency electrical energy to the tissue under laparoscopic and laparoscopic ultrasound direction 24 or transcervically utilizing the guidance provided by transvaginal ultrasound. ...
... 82 In the past, hysterectomy was the only available and effective treatment for adenomyosis. 21 However, medical management and image-guided techniques can now be used successfully in many instances and depending on the patient's current and future goals regarding pregnancy. ...
... 22 Studies have shown promising results, with improvements reported in dysmenorrhea and blood loss; however, data on the effect of UAE on fertility are still lacking. 21,22 A recent meta-analysis concluded that 82% of patients undergoing UAE avoided a hysterectomy, and quality of life and symptom severity were improved at the 3-month and 7-year follow up. 93 The QUESTA trial (Quality of Life after Embolization vs. ...
Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories—medical and surgical—and while medical management is typically regarded as first‐line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision‐making are considered in this article.
... The mechanism involves the disruption of the pathways, which lead to inflammation, neuroangiogenesis, and impaired apoptosis. Presently, various hormonal and non-hormonal options, namely gonadotropinreleasing hormone (GnRH) analogues, selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), selective progesterone receptor modulators (SPRMs), combined oral contraceptive, and non-steroidal anti-inflammatory drugs are being used for the symptomatic treatment of adenomyosis [53]. Newer drugs, such as aromatase inhibitors, have also been investigated by Badawy et al. and Rosti et al, while other therapies such as selective progesterone receptor modulators, GnRH antagonist, valproic acid, and antiplatelet therapies are still under investigation [54]. ...
... Non-excisional treatments aim to induce necrosis of focal or diffuse adenomyosis through selective vascular occlusion or focused ultrasound/thermal energy without direct tissue dissection. In some cases, a combination of surgical and non-excisional methods, i.e., hysteroscopy resection/ ablation, are used to achieve maximum cytoreduction and reduce myometrial tissue damage [53]. ...
... Laparoscopic techniques have also been described in more focal pathology [53]. Laparoscopic adenomyomectomy with hysteroplasty-transverse incision is made in the adenomyotic tissue down to the endometrium. ...
Aim: Adenomyosis is an abnormal overgrowth of the endometrial tissues within the myometrium causing enlargement of the uterus. This present review will focus on clinical symptoms, diagnostic approach, image findings, complications, and management of Adenomyosis. The goal is also to highlight the recent advances in the topic. Methodology: A total of 15 articles published in various journals have been included to write the current review. PubMed, Research Gate, Scopus, Springer are some of the databases used for the literature search. Results: After reviewing the literature Adenomyosis has been discussed under the following topics 1) epidemiology (known and emerging risk factors) 2) Pathogenetic Theories (recent advances such as sequencing analysis of epithelial cells in Adenomyosis) 3) Clinical Manifestations and impact on women's fertility and pregnancy outcome 4)Diagnostic Approach, Current imaging techniques and classifications 5) Medical Management 6) Surgical Interventions (with recent advances such as UAE) 7) Future Perspective. Conclusion: The prevalence of Adenomyosis is still unknown owing to the lack of a validated standard diagnostic approach. Historically, the standard treatment of adenomyosis has been hysterectomy, but this is not always the best option, especially for women who want to preserve their fertility or for those who are poor surgical candidates.
... Moreover, women with adenomyosis still need to be continually treated with drugs after conservative surgery [3] . Although uterine artery embolization (UAE) and high-intensity focused ultrasound (HIFU) can also be used to treat adenomyosis, the efficacy and safety of these treatments are still being debated [6][7][8][9] . Therefore, medication is the mainstream treatment in the lifelong management plan for adenomyosis [10] . ...
Objective: To study the 12-month effects and possible mechanisms of low-dose mifepristone in the treatment of adenomyosis. Methods: Patients included in this retrospective study had painful adenomyosis and previously received 5 mg mifepristone daily (group A, n = 45) or 5 mg mifepristone daily with a poor-effect levonorgestrel-releasing intrauterine device (group B, n = 13) for 12 months. Uterine size, serum CA125 levels, estradiol levels, Visual Analogue Scale (VAS) score, endometrial thickness, and hemoglobin levels were compared before and after treatment and investigated again at 3 to 6 months after drug withdrawal. Another 8 patients with adenomyosis (group C, n = 8) who underwent surgery for severe dysmenorrhea during the same period were only used as a control group for immunohistochemical research. Endometrial biopsy results and expression of nerve growth factor (NGF), cyclooxygenase-2 (COX-2), and nuclear-associated antigen Ki-67 (Ki-67) in endometrial tissues and adenomyotic lesions were also analyzed. Results: The VAS scores in both experimental groups at all time points during treatment and follow-up were significantly lower (P <0.001) than those before treatment. The uterine size was significantly reduced, and endometrial thickness was distinctly thicker after 12 months of treatment than that before treatment in group A receiving 5 mg/d mifepristone. The immunohistochemical expression of NGF and COX-2 decreased in both eutopic and ectopic endometrium after treatment, whereas that of Ki-67 slightly increased in eutopic endometrium after treatment and rapidly recovered to the baseline value after stopping mifepristone. There were no signs of hyperplasia, atypical hyperplasia, or malignancy in the endometrial biopsies. Conclusions: The results suggested that a daily dose of 5 mg mifepristone for 12 months down-regulated the expression of NGF and COX-2 and was effective in treating painful adenomyosis with few side effects.
... The mechanism involves the disruption of the pathways, which lead to inflammation, neuroangiogenesis, and impaired apoptosis. Presently, various hormonal and non-hormonal options, namely gonadotropinreleasing hormone (GnRH) analogues, selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), selective progesterone receptor modulators (SPRMs), combined oral contraceptive, and non-steroidal anti-inflammatory drugs are being used for the symptomatic treatment of adenomyosis [53]. Newer drugs, such as aromatase inhibitors, have also been investigated by Badawy et al. and Rosti et al, while other therapies such as selective progesterone receptor modulators, GnRH antagonist, valproic acid, and antiplatelet therapies are still under investigation [54]. ...
... Non-excisional treatments aim to induce necrosis of focal or diffuse adenomyosis through selective vascular occlusion or focused ultrasound/thermal energy without direct tissue dissection. In some cases, a combination of surgical and non-excisional methods, i.e., hysteroscopy resection/ ablation, are used to achieve maximum cytoreduction and reduce myometrial tissue damage [53]. ...
... Laparoscopic techniques have also been described in more focal pathology [53]. Laparoscopic adenomyomectomy with hysteroplasty-transverse incision is made in the adenomyotic tissue down to the endometrium. ...
Aim: Adenomyosis is an abnormal overgrowth of the endometrial tissues within the myometrium causing enlargement of the uterus. This present review will focus on clinical symptoms, diagnostic approach, image findings, complications, and management of Adenomyosis. The goal is also to highlight the recent advances in the topic.
Methodology: A total of 15 articles published in various journals have been included to write the current review. PubMed, Research Gate, Scopus, Springer are some of the databases used for the literature search.
Results: After reviewing the literature Adenomyosis has been discussed under the following topics 1) epidemiology (known and emerging risk factors) 2) Pathogenetic Theories (recent advances such as sequencing analysis of epithelial cells in Adenomyosis) 3) Clinical Manifestations and impact on women's fertility and pregnancy outcome 4)Diagnostic Approach, Current imaging techniques and classifications 5) Medical Management 6) Surgical Interventions (with recent advances such as UAE) 7) Future Perspective.
Conclusion: The prevalence of Adenomyosis is still unknown owing to the lack of a validated standard diagnostic approach. Historically, the standard treatment of adenomyosis has been hysterectomy, but this is not always the best option, especially for women who want to preserve their fertility or for those who are poor surgical candidates.
... Adenomyosis is a common gynecological disease in women of childbearing age [1] and has been vaguely described as a benign condition of endometrial tissue that involves gland and stromal invasion into the myometrium, thus leading to an enlarged uterus [2]. The different clinical manifestations of adenomyosis are as follows: 40-60% of patients have excessive menstruation, 15-30% of patients have dysmenorrhea, and 30% of patients have no obvious symptoms [3]. ...
Adenomyosis has been associated with adverse fertility and pregnancy outcomes, and its impact on the outcomes of in vitro fertilization (IVF) has received much attention. It is controversial whether the freeze-all strategy is better than fresh embryo transfer (ET) in women with adenomyosis. Women with adenomyosis were enrolled in this retrospective study from January 2018 to December 2021 and were divided into two groups: freeze-all (n = 98) and fresh ET (n = 91). Data analysis showed that freeze-all ET was associated with a lower rate of premature rupture of membranes (PROM) compared with fresh ET (1.0% vs. 6.6%, p = 0.042; adjusted OR 0.17 (0.01–2.50), p = 0.194). Freeze-all ET also had a lower risk of low birth weight compared with fresh ET (1.1% vs. 7.0%, p = 0.049; adjusted OR 0.54 (0.04–7.47), p = 0.642). There was a nonsignificant trend toward a lower miscarriage rate in freeze-all ET (8.9% vs. 11.6%; p = 0.549). The live birth rate was comparable in the two groups (19.1% vs. 27.1%; p = 0.212). The freeze-all ET strategy does not improve pregnancy outcomes for all patients with adenomyosis and may be more appropriate for certain patients. Further large-scale prospective studies are needed to confirm this result.
... This disease detrimentally impacts quality of life through fertility, menstrual symptoms, and pregnancy outcomes therefore requires lifelong management [50]. Conservative surgical options, hysteroscopic resections/ablations, and uterine artery embolization are methods to treat adenomyosis surgically [51]. 18% of hysterectomies in our patient pool were undergone by women with adenomyosis. ...
Introduction:
Chronic Pelvic Pain (CPP) is a complex, multifaceted condition that affects both women and men. There is limited literature on the cost utilization the healthcare system and CPP patients incur. The purpose of this analysis is to characterize the overall healthcare utilization, cost burden, and quality-of-life restrictions experienced by CPP patients using data from an outpatient pelvic rehabilitation practice.
Methods:
Healthcare utilization data was gathered by systematically reviewing and analyzing data from new patient visit progress notes stored in the clinic's electronic health records (EHR). We obtained in-network costs by using the FAIR Health Consumer online database. Overall costs were then calculated as the utilization times the per-unit costs from the FAIR database. Additionally, data on patients' visual analogue scale (VAS), absenteeism, presenteeism emergency room visits, usage of common pain medications, use of diagnostics, and participation in common treatment modalities was gathered.
Results:
Data from 607 patients was used. The overall cost burden per patient for all surgeries combined was $15,750 for in-network services. The cost burden for diagnostics was $5,264.22 and treatments was $8,937 per patient for in-network treatments.
Conclusion:
Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries. This analysis sets the stage for future investigations involving data on costs of medications that patients have tried prior to presenting to us and costs associated with work hours lost.
