Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy

Abstract

!Adenomyosis is an important clinical challenge in gynecology and healthcare economics; in its fully developed form, hysterectomy is often used to treat it in premenopausal and perimenopausal women. Symptoms of adenomyosis typically include menorrhagia, pelvic pain and dysmenorrhea. Moreover, adenomyosis and leiomyomas commonly coexist in the same uterus, and differentiating the symptoms for each pathological process can be problematic. Although it has been recognized for over a century, reliable epidemiological studies on this condition are limited, because only postoperative diagnoses were possible in the past. Minimally invasive surgical techniques (endometrial ablation/resection, myometrial excision/reduction, myometrial electrocoagulation, uterine artery ligation) have had limited success in the treatment of adenomyosis, and the reported data for these procedures have been obtained from case reports or small case series with only short follow-up times. However, newer techniques including uterine artery embolization (UAE) and magnetic resonance imaging guided focused ultrasound (MRgFUS) show promise in treating adenomyosis. The data is strongest for UAE; these studies have the largest patient cohorts. However, none of the UAE studies were randomized or controlled. Thus, despite the clinical importance of adenomyosis, there is little evidence on which to base treatment decisions. The objective of this review is to summarize the epidemiology, risk factors, clinical phenotype and to evaluate the accrued experience with surgical and interventional alternatives to hysterectomy.

Chlamydia muridarum Induction of Glandular Duct Dilation in Mice

“…The current study has correlated uterine horn dilation with glandular duct dilation, which has laid the foundation for further addressing whether the C. muridarum-induced uterine horn dilation has any relevance to C. trachomatis pathogenesis in women. Although no women have ever been diagnosed with glandular duct dilation, diseases that involve glandular duct dilation, such as adenomyosis, are quite common in women (47). Adenomyosis is an important clinical challenge in gynecology.…”

The Decreasing Length of Hospital Stay following Vaginal Hysterectomy: 2011–2012 vs. 1996–1997 vs. 1995–1996

“…This is relatively stable with respect to the identified indications for vaginal hysterectomy in the study population, in contrast to e.g. adenomyosis uteri [13], in the case of which increasingly alternative therapeutic approaches are used. In the current study period, 40 patients (53.3%) were admitted on the day of surgery.…”

“…Reduktion der Aufenthaltsdauer war kein explizites Ziel. Ergebnisse: Der mediane postoperative Aufenthalt verkürzte sich von 7 (5-9) auf 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) bzw. 3 (0-5) Tage (p < 0,001).…”

Ozone therapy of the adenomyosis at women with sterility and hypothyroidism

“…Якщо частота генітального ендометріозу ко-ливається від 12 до 50 %, то аденоміоз сягає 55-80 % в структурі ендометріозу [6,7]. Аденоміоз -одна з форм ендометріоїдної хвороби, для якої характерний прогресуючий інвазивний рост тканини ендометрія в товщу міометрію тіла матки, яка супроводжується гіперплазією та гіпертрофією гладких м′язів міоме-трію, при цьому встановлені порушення локального імунітету [8].…”