Update on the surgical management of adenomyosis

Abstract

Adenomyosis is a benign gynaecological condition associated with menstrual symptoms and pelvic pain in premenopausal women, it has also been linked to subfertility. Improvement in ultrasound and MRI imaging has allowed accurate diagnosis of this condition prior to histological confirmation. Patients opting for surgical management need to be counselled regarding the surgical options available. This review summarizes the surgical management of adenomyosis and reviews the recent surgical developments. For patients who wish to preserve their fertility, cytoreductive surgery is an option in centres with surgical expertise. Recently, modified surgical procedures to remove extensive adenomyosis known as an adenomyomectomy have been described. These operations may enhance subsequent fertility. Access to accurate imaging modalities such as MRI and transvaginal ultrasound allows for adequate patient counselling preoperatively. Depending on the fertility requirements and the extent of adenomyosis, patients can be offered various surgical treatment options including laparoscopic hysterectomy or adenomyomectomy.