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.
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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.
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Epidemiology
Adenomyosis is a common condition, with prevalence estimated at 21.8% in patients undergoing surgery for endometriosis.
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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.
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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.
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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)....
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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.
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Indications for testing
Diagnostic investigations
Medical management
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.
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Thermal ablation
Perioperative care
Surgical interventions
Adenomyomectomy: as per SOGC 2023 guidelines, Perform adenomyomectomy as a treatment option in patients with symptomatic adenomyosis.
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Total hysterectomy