Adenomyosis

Abstract

The usual treatment for severe adenomyosis has been hysterectomy, because its removal is complicated by infiltrative tissue destruction of normal uterine myometrium.. Yet many women wish to retain their uterus to preserve their ability to become pregnant and carry babies. Our objective was to see if it is possible to remove very large, symptomatic adenoymas with a technique that allows safe future childbearing. Complete excision of adenomyotic tissue and reconstruction of the uterine wall by a triple-flap method to prevent uterine rupture in subsequent pregnancies. From June 1998 to August 2017, 113 women with very severe adenomyosis who desired pregnancy, and all of whom had severe and debilitating symptoms were enrolled and followed for relief of symptoms and successful pregnancy and live birth. A dramatic reduction of menstrual symptoms occurred immediately and 69.5% of women delivered a healthy baby at term without any incidence of uterine rupture. Adenomyosis is a disabling disease in women that until recently had been treated by hysterectomy. However, many patients wish to preserve their uterus for childbearing, necessitating the need for a more effective conservative approach in treating this disease. The “triple-flap method” described here has not only significantly decreased the symptoms of adenomyosis but has also increased fertility in these patients with no incidence of uterine rupture. A successful live baby delivery rate of 69.5% has been achieved in these women who otherwise would have undergone hysterectomy.