Abstract
AbstractBackgroundAdenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts.ObjectiveDescription of diagnostic and therapeutic approaches in patients with adenomyosis in relation to patient age, family planning status, peritoneal and/or deep endometriosis and symptoms.MethodsThe current literature on adenomyosis including case reports was analyzed. Due to the lack of evidenced-based approaches the most probable trends in diagnostics and treatment are discussed.ResultsAdenomyosis plays an important role in fertile patients with dysmenorrhea, dyspareunia and pelvic pain, with or without additional peritoneal or deep endometriosis. It has a negative impact on fertility and can cause a variety of symptoms. The disease can be diagnosed by a skilled examiner and treatment concepts exist.ConclusionAdenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. Various medical and surgical treatment approaches are available to reduce symptoms and to increase fertility. The course of action depends on the family planning status of the patient.
Highlights
Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts
The histologic proof can be helpful in therapeutic decisions, especially in cases of adenomyosis-related infertility
All diagnostic findings in adenomyosis can change in relation to patient age, hormonal treatment and menstrual cycle
Summary
Adenomyosis can cause dysmenorrhea, dyspareunia, bleeding disorders and pelvic pain and has a negative impact on fertility. A risk for obstetric complications in patients with adenomyosis has recently been reported regarding premature birth, premature rupture of membranes, uterine rupture, postpartum hemorrhage, placentation failure and intrauterine fetal growth reduction [2] It has been reported in various publications that medicinal and surgical treatment of adenomyosis may improve fertility [3] and reduces symptoms, a standard for the treatment of infertile women with adenomyosis has not yet been established [4]. The most important diagnostic sign in MR imaging seems to be the irregularity of the junctional zone (JZ), followed by focal or diffuse thickening of the JZ, a JZ(max) to myometrial thickness ratio >40%, areas of myometrial low signal intensity and high signal intensity spots in the T2-weighted technique are the typical findings [12, 13]. In patients with additional uterine myomas the sensitivity was higher in MR imaging [12]
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