Abstract
BackgroundHistorically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis.MethodsWe selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively.ResultsA total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy.ConclusionsPatients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.
Highlights
Hysterectomy has been the radical treatment for adenomyosis
Exclusion criteria were the absence of symptoms due to adenomyosis, absence of pre-treatment imaging, request for hysterectomy at the first visit, presence of submucosal myoma, presence of an intramyometrial myoma of more than 3 cm diameter, and/or presence of more than 3 fibroids that drain the endometrium were excluded because the later could cause heavy menstrual bleeding or abnormal uterine bleeding in addition to adenomyosis
A total of 885 patients were diagnosed with adenomyosis and started on treatment; 694 with no symptoms or no pre-treatment imaging, 51 who requested a hysterectomy at the time of first visit, and 16 with submucosal myoma or intramyometrial myoma of more than 3 cm and more than 3 fibroids, and 124 patients were started on conservative treatment (Fig. 2)
Summary
Some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. Even with hormone therapy for adenomyosis, patients often experience persistent symptoms, including pain and drug side effects, such as irregular bleeding or osteoporosis, that result in the need for hysterectomy [10, 12,13,14]. To date, it has been unclear which women can continue conservative treatment for adenomyosis. The identification of factors related to the success or failure of conservative treatment would greatly contribute to the choice of treatment strategy, and significantly benefit the quality of life of women and the health care economy
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