Adenomyosis and Abnormal Uterine Bleeding (AUB-A)—Pathogenesis, diagnosis, and management

Abbott, Jason

doi:10.1016/j.bpobgyn.2016.09.006

Cited by 140 publications

(108 citation statements)

References 94 publications

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“…Ultrasound and MRI studies demonstrate similar sensitivities in diagnosing adenomyosis, but MRI has higher specificity compared to ultrasound . Ultimately, adenomysis is a histologic diagnosis . Medical treatment for adenomyosis is similar to that of endometriosis.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…Medical treatment for adenomyosis is similar to that of endometriosis. LNG‐IUD, GnRH agonists, danazol, oral progestins and aromatase inhibitors have all been effective in treating adenomyosis related symptoms . Surgical treatment includes fertility‐sparing surgeries such as excision or cytoreductive procedures, and non‐fertility sparing procedures such as endometrial ablation, uterine artery embolization or hysterectomy …”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…30 Ultimately, adenomysis is a histologic diagnosis. 31 Medical treatment for adenomyosis is similar to that of endometriosis. LNG-IUD, GnRH agonists, danazol, oral progestins and aromatase inhibitors have all been effective in treating adenomyosis related symptoms.…”

Section: Diagnosis and Management Endometriosis And Adenomyosismentioning

confidence: 99%

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Gynecological associated disorders and management

et al. 2019

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Background Chronic pelvic pain syndrome is complex and involves multiple organ systems. The gynecological aspects of chronic pelvic pain syndrome can be divided into four different areas: intra‐abdominal, vaginal, pelvic floor muscles and sexual pain. This article provides an overview of gynecological evaluation in patients with chronic pelvic pain and reviews the most common gynecological diagnoses and their management. Methods An extensive review of the literature including guidelines from the International Continence Society, the European Association of Urology, and the International Association for the Study of Pain was performed. Results Gynecological evaluation of patients with chronic pelvic pain begins with a thorough history and physical examination. Laboratory tests, imaging studies and diagnostic procedures can be used as adjuncts to make a diagnosis. Treatment modalities include physical therapy, medications, trigger points injections, and surgery. Conclusion Common gynecological diagnoses of chronic pelvic pain include endometriosis, adenomyosis, vulvodynia, high tone pelvic floor dysfunction, and genitopelvic pain/penetration disorder. Gynecology is one of the many systems that can be associated with chronic pelvic pain. Managing patients with chronic pelvic pain requires a multimodal and multidisciplinary approach.

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Section: Diagnosis and Managementmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

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Gynecological associated disorders and management

et al. 2019

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“…[5] Treatment options vary according to different symptoms and fall into the following categories: medical treatments, surgical procedures, radiologic or sonographic interventions, or combinations of these choices. [6]…”

Section: Introductionmentioning

confidence: 99%

Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

Dai

et al. 2017

Chinese Medical Journal

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Background:Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms (LUTS) among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population.Methods:From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasonographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio (OR) and 95% confidence interval (CI).Results:Compared with the control group, patients with adenomyosis had a greater IPSS total (4 [2–8] vs. 2 [0–3], Z = –8.159, P < 0.001), IPSS storage (2 [1–4] vs. 1[0–2], Z = –7.361 P < 0.001), and IPSS voiding (2 [0–4] vs. 0 [0–1], Z = –7.194, P < 0.001). Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms (IPSS ≥8). The most prevalent LUTS were daytime frequency (40.9%), followed by nocturia (24.8%), weak stream (24.2%), and incomplete emptying (23.5%). In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia (51.1% vs. 30.8%, χ2 = 11.162 P = 0.025) and larger uterine volumes (183.3 [109.8–273.8] cm3 vs. 148.5 [96.4–262.7] cm3, Z = –1.441, P = 0.150) compared to patients with an IPSS total score <8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score ≥8 (OR: 2.309, 95% CI: 1.310–4.070, P = 0.004), an IPSS storage subscore ≥4 (OR: 2.422, 95% CI: 1.395–4.206, P = 0.002), and an IPSS voiding subscore ≥5 (OR: 1.971, 95% CI: 1.176–3.302, P = 0.010). However, patients with uterine volume more than 180 cm3 had more than 2-fold risk of bearing IPSS total score ≥8 (OR: 2.437, 95% CI: 1.381–4.300, P = 0.002), IPSS storage subscore ≥4 (OR: 2.486, 95% CI: 1.433–4.314, P = 0.001), and IPSS voiding subscore ≥5 (OR: 2.700, 95% CI: 1.485–4.908, P = 0.001).Conclusions:Lower urinary tract symptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients’ quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.

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“…[3][4][5][6][7] The treatment options for adenomyosis are summarized by Soave et al 8 and mainly include medical treatment, high intensity focused ultrasound (HIFU), surgery and combination therapy. 9 However, numerous challenges are emerging including notable side-effects, limited efficacy and heavy financial burden. 9 However, numerous challenges are emerging including notable side-effects, limited efficacy and heavy financial burden.…”

mentioning

confidence: 99%

A new trick for an old dog: The application of mifepristone in the treatment of adenomyosis

Che

Wang

et al. 2019

J Cellular Molecular Medi

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Adenomyosis is also called internal endometriosis and affects about 20% of reproductive‐aged women. It seriously reduces life quality of patients because current drug therapies face with numerous challenges. Long‐term clinical application of mifepristone exhibits wonderful therapeutic effects with mild side‐effects in many disorders since 1982. Since adenomyosis is a refractory disease, we investigate whether mifepristone can be applied in the treatment of adenomyosis. In this study, we investigated the direct effects of mifepristone on human primary eutopic endometrial epithelial cells and stromal cells in adenomyosis. We found that mifepristone causes cell cycle arrest through inhibiting CDK1 and CDK2 expressions and induces cell apoptosis via the mitochondria‐dependent signalling pathway in endometrial epithelial cells and stromal cells of adenomyosis. Furthermore, mifepristone inhibits the migration of endometrial epithelial cells and stromal cells through decreasing CXCR4 expression and restricts the invasion of endometrial epithelial cells via suppression of epithelial‐mesenchymal transition in adenomyosis. We also found that mifepristone treatment decreases the uterine volume, CA125 concentration and increases the haemoglobin concentration in serum for adenomyosis patients. Therefore, we demonstrate that mifepristone could serve as a novel therapeutic drug in the treatment of adenomyosis, and therefore, the old dog can do a new trick.

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Adenomyosis and Abnormal Uterine Bleeding (AUB-A)—Pathogenesis, diagnosis, and management

Cited by 140 publications

References 94 publications

Gynecological associated disorders and management

Gynecological associated disorders and management

Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

A new trick for an old dog: The application of mifepristone in the treatment of adenomyosis

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