Home

Loading...

Table of contents

Adenomyosis

What's new

Added 2023 SOGC and 2023 ESHRE guidelines for the diagnosis and management of adenomyosis.

Background

Overview

Definition
Adenomyosis is a condition characterized by the presence of endometrial tissue within the myometrium.
1
Pathophysiology
The pathophysiology of adenomyosis involves the disruption of the endometrial-myometrial boundary, leading to the formation of ectopic endometrial glands and stroma in the myometrium.
1
Epidemiology
Adenomyosis is a common condition, with prevalence estimated at 21.8% in patients undergoing surgery for endometriosis.
2
Disease course
Clinically, adenomyosis is associated with heavy menstrual bleeding, pelvic pain, infertility, miscarriage, and adverse pregnancy outcomes. These symptoms can significantly impact a woman's QoL. Adenomyosis often coexists with other gynecological conditions, such as endometriosis or fibroids, which can complicate the clinical presentation.
1
3
Prognosis and risk of recurrence
The prognosis of adenomyosis is generally benign, as it is not a malignant condition. However, it can significantly impact the QoL due to the associated symptoms.
4

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of adenomyosis are prepared by our editorial team based on guidelines from the European Society of Human Reproduction and Embryology (ESHRE 2023), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023), and the Royal College of Obstetricians and Gynaecologists (RCOG 2012). ...
Show more

Screening and diagnosis

Clinical presentation: as per SOGC 2023 guidelines, recognize that adenomyosis is associated with heavy menstrual bleeding, pelvic pain, infertility, miscarriage, and adverse pregnancy outcomes.
B
Create free account

More topics in this section

  • Indications for testing

Diagnostic investigations

Diagnostic imaging: as per SOGC 2023 guidelines, obtain transvaginal ultrasound as first-line imaging of suspected adenomyosis in patients with heavy menstrual bleeding, pelvic pain, infertility, miscarriage, and adverse pregnancy outcomes.
A
Show 2 more

Medical management

Hormonal therapy: as per SOGC 2023 guidelines, offer oral contraceptives, levonorgestrel-releasing intrauterine system, and dienogest as first-line therapy for pain and heavy menstrual bleeding in patients with adenomyosis.
B
Show 2 more

Therapeutic procedures

Uterine artery embolization: as per SOGC 2023 guidelines, consider offering uterine artery embolization for heavy bleeding and pain associated with adenomyosis in patients completed child-bearing and wishing to preserve their uterus.
B

More topics in this section

  • Thermal ablation

Perioperative care

Correction of anemia: as per SOGC 2023 guidelines, correct anemia (hemoglobin < 120 g/L) before adenomyomectomy given the substantial risk of intraoperative hemorrhage.
B

Surgical interventions

Adenomyomectomy: as per SOGC 2023 guidelines, perform adenomyomectomy as a treatment option in patients with symptomatic adenomyosis.
B
Show 2 more

More topics in this section

  • Total hysterectomy

Patient education

Fertility counseling: as per SOGC 2023 guidelines, counsel patients undergoing fertility treatments that the impact of adenomyosis on pregnancy outcomes is uncertain.
B

More topics in this section

  • Preoperative counseling