New paradigms in the conservative surgical and interventional management of adenomyosis

Farah A. Alvi*, Laura M. Glaser, Angela Chaudhari, Susan Tsai, Magdy P. Milad

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations

Abstract

Purpose of review: Adenomyosis is commonly diagnosed in women of reproductive age. Interest in conservative interventions has grown as more women desire fertility preservation or avoidance of hysterectomy. This review discusses surgical and interventional methods for treatment of symptomatic adenomyosis. The technique, evidence, and utility of each method are described. Recent findings: Hysteroscopic ablative techniques are associated with lower morbidity than with hysterectomy but may result in an unacceptable risk of treatment failure. Surgical adenomyomectomy may provide good symptomatic improvement, especially when combined with preoperative gonadotropin-releasing hormone agonist treatment. Laparoscopic myometrial coagulation is associated with high rates of future pregnancy complications. Uterine artery ligation has limited value as an isolated approach but, coupled with other techniques, provides adequate therapeutic control. Bilateral uterine artery embolization may improve symptoms, without significantly compromising fertility. Focused ultrasonic surgical methods also show promise in alleviating symptoms without compromising reproductive outcomes. Summary: A multitude of surgical and interventional options are available for young women with symptomatic adenomyosis. These treatment methods have unique associated risks and benefits, and may have varying impacts on long-term symptom control, fertility, and reproductive outcomes.

Original languageEnglish (US)
Pages (from-to)240-248
Number of pages9
JournalCurrent Opinion in Obstetrics and Gynecology
Volume29
Issue number4
DOIs
StatePublished - Aug 1 2017

Keywords

  • adenomyosis
  • fertility
  • gynecologic surgery
  • uterine artery embolization

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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