Diffuse massive adenomyosis and infertility. Is it possible to treat this condition?

Abstract

Background Severe forms of adenomyosis are a serious gynecological problem. In most cases, conservative treatment of this pathology is unsuccessful. Adenomyomectomy by Osada’s approach seems to be the most promising solution. The present study evaluated the follow-up results of this type of surgery in patients with adenomyosis and infertility. Materials and methods The prospective study included 26 patients with severe forms of adenomyosis who underwent an adenomyomectomy using Osada’s approach. In 18 patients (69%), infertility was the main indication for surgical treatment. The follow-up period lasted from July 2012 to January 2018. Results The median post-operative follow-up period was 18 months. For the first 12 months patients received hormonal therapy. In all postoperative patients, the menstrual cycle had normalized, and other symptoms of the disease had disappeared. Seven patients continue to receive postoperative hormonal treatment. Three individuals got spontaneously pregnant; two of them delivered full-term babies by cesarean section. Six patients are planning a pregnancy with assisted reproductive technology. Conclusion In the present study, the organ-preserving surgery of severe adenomyosis performed using Osada’s method appeared to be a good alternative to hysterectomy. It stopped the development of pathological symptoms of the disease and restored the patient’s reproductive function.

Imaging Spectrum of Benign Uterine Disease and Treatment Options

“…While it is estimated that up to one-third of patients with adenomyosis are asymptomatic, the symptoms of adenomyosis are common but are nonspecific including dysmenorrhea, menorrhagia, and abnormal vaginal bleeding. Adenomyosis is associated with female infertility possibly in part due to the overlapping pathophysiology and association with endometriosis 52 . The etiology of adenomyosis is still unclear 4 .…”