Epidemiology of Adenomyosis

Upson, Kristen; Missmer, Stacey A.

doi:10.1055/s-0040-1718920

Cited by 99 publications

(110 citation statements)

References 128 publications

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“…Chronic peristaltic myometrial contractions can lead to micro lesions close to the endometrial-myometrial junction causing inflammation which in turn leads to an increase in local production of estrogen inducing a vicious cycle. Thus, the TIAR theory highlights the importance of tissue damages to the endometrial-myometrial interface supporting the common knowledge that the adenomyosis is associated with multiple births, previous cesarean section and previous uterine surgery [53]. However, it is known that there is a considerable number of macrophages in the ectopic endometrium of patients with endometriosis, fibroids and adenomyosis.…”

Section: Adenomyosismentioning

confidence: 64%

Recurrent Implantation Failure: The Role of Anatomical Causes

Barcelos¹,

Filho²,

Goulart³

et al. 2021

Infertility and Assisted Reproduction

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Recurrent implantation failure (RIF) is one of the great challenges of current reproductive medicine. The term refers to the failure of repeated transfers of embryos of good morphological quality. Embryo implantation is a crucial moment in in vitro fertilization (IVF) treatments. A successful pregnancy depends on a synchronized interaction between a good quality embryo and a receptive endometrium. Its failure may be a consequence of embryo quality, anatomical or immunological factors. The anatomic causes constitute an important factor for RIF, although they are usually manageable. Fibroids, polyps and adhesions that develop after a surgical procedure or infection can hamper the embryo - endometrium attachment process. In addition, Mullerian abnormalities and hydrosalpinx can cause a negative impact on implantation rates and should also be taken into account in patients with RIF. In this chapter, we will address the main anatomical causes that may impact the implantation rates of patients undergoing IVF, as well as recommendations on management and its treatment.

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Section: Adenomyosismentioning

confidence: 64%

Recurrent Implantation Failure: The Role of Anatomical Causes

Barcelos¹,

Filho²,

Goulart³

et al. 2021

Infertility and Assisted Reproduction

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show abstract

Section: Introductionmentioning

confidence: 99%

“…Adenomyosis is a common benign disease of the uterus that can be found in 20–70% of patients, depending on the characteristics of study populations ( Upson and Missmer, 2020 ). Despite its reported negative impact on quality of life (QOL), fertility and obstetric outcomes ( Harada et al , 2019 ; Horton et al , 2019 ; Upson and Missmer, 2020 ), data on the efficacy of treatments for adenomyosis are lacking. Systematic reviews evaluating interventions for adenomyosis have been unable to perform quantitative data-synthesis of commonly reported outcomes, such as abnormal uterine bleeding, due to the variation in outcome reporting ( de Bruijn et al , 2017 ; Abbas et al , 2020 ).…”

Section: Introductionmentioning

confidence: 99%

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

Tellum

Omtvedt

Naftalin

et al. 2021

Human Reproduction Open

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STUDY QUESTION Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis? SUMMARY ANSWER We identified 38 studies, reporting on 203 outcomes using 133 outcome measures. WHAT IS KNOWN ALREADY Heterogeneity in outcome evaluation and reporting has been demonstrated for several gynaecological conditions and in fertility studies. In adenomyosis, previous systematic reviews have failed to perform a quantitative analysis for central outcomes, due to variations in outcome reporting and measuring. STUDY DESIGN, SIZE, DURATION A systematic search of Embase, Medline and Cochrane Register of Controlled Trials (CENTRAL) was performed with a timeframe from 1950 until February 2021, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). PARTICIPANTS/MATERIALS, SETTING, METHODS Studies reporting on any uterus-sparing intervention to treat adenomyosis, both prospective and retrospective, were eligible for inclusion. Inclusion criteria were a clear definition of diagnostic criteria for adenomyosis and the modality used to make the diagnosis, a clear description of the intervention, a follow up time of ≥ 6 months, a study population of n ≥ 20, a follow up rate of at least 80%, and English language. The population included premenopausal women with adenomyosis. Risk of bias was assessed using the Evidence Project risk of bias tool. MAIN RESULTS AND THE ROLE OF CHANCE We included 38 studies (6 randomized controlled trials and 32 cohort studies), including 5175 participants with adenomyosis. The studies described 10 interventions and reported on 203 outcomes, including 43 classified as harms, in 29 predefined domains. Dysmenorrhea (reported in 82%), heavy menstrual bleeding (HMB) (in 79%) and uterine volume (in 71%) were the most common outcomes. Fourteen different outcome measures were used for dysmenorrhea and 17 for HMB. Quality of life was reported in 9 (24%) studies, patient satisfaction with treatment in 1 (3%). A clear primary outcome was stated in only 18%. LIMITATIONS, REASONS FOR CAUTION This review includes studies with a high risk of bias. WIDER IMPLICATIONS OF THE FINDINGS Shortcomings in the definition and choice of outcomes and outcome measures limit the value of the conducted research. The development and implementation of a core outcome set (COS) for interventional studies in adenomyosis could improve research quality. This review suggests a lack of patient centred research in adenomyosis and people with adenomyosis should be involved in the development and implementation of the COS. STUDY FUNDING/COMPETING INTEREST(S) No funds specifically for this work was received. TT receives fees from General Electrics for lectures on ultrasound independently of this project. TRIAL REGISTRATION NUMBER This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020177466) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative (registration number 1649).

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“…It is common in women of reproductive age, and typical symptoms include menorrhagia, chronic pelvic pain, and dysmenorrhea. [1][2][3] Current treatment options for symptomatic AD include hysterectomy, medication, conservative surgery, and minimally invasive techniques, including uterine artery embolization (UAE). However, to date, hysterectomy remains the definitive treatment.…”

Section: Introductionmentioning

confidence: 99%

Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up

Yuan

Zhang

Yan

et al. 2021

IJGM

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Purpose: To assess the long-term outcome of performing uterine artery embolization (UAE) using small particles in women with symptomatic adenomyosis (AD). Methods: Twenty-seven consecutive women (median age 42 years, range 29-53 years) with AD, in eight cases AD combined with fibroids, who underwent UAE between February 2015 and January 2019, were retrospectively analyzed. The embolization was performed using small-sized polyvinyl alcohol particles (100 μm and 300 μm). The patients completed the Uterine Fibroid Symptom and Quality of Life questionnaire at baseline and at a 42-month follow-up (range 24-71). The junction zone (JZ) thickness and uterine volume were also calculated at baseline and at a three-month follow-up. Results: The total symptom severity score (SSS) decreased from a median of 59 (range 34-78) at baseline to a median of 9 (range 3-47) at the end of this study; the health-related quality of life score (HRQOL) increased from a median of 38 (range 23-49) at baseline to a median of 84 (range 46-97) at 42 months. Twenty of the 27 patients were asymptomatic. The clinical response of the remaining seven women was little improvement in their symptoms, and one of the seven women underwent a hysterectomy at 35 months. Twentysix of the 27 (96%) patients had a preserved uterus at the 42-month follow-up. There was no difference after UAE in SSS, HRQOL, junction zone (JZ) thickness, and uterus volume between patients with pure AD and those with AD combined with fibroids (p = 0.729, 0.710, 0.973, and > 0.99). There was no difference in the JZ thickness and uterus volume at baseline between the asymptomatic women and the women with an insufficient response (p = 0.854 and 0.253), and there were no major complications afterwards. Conclusion: From the long-term follow-ups, it could be seen that UAE using small particles is safe and effective in treating AD, especially in preserving the uterus. There is no relationship between the clinical outcomes and the initial presence of AD, with or without fibroids, and the JZ thickness at baseline does not seem to be a predictor for the long-term outcome of UAE.

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Epidemiology of Adenomyosis

Cited by 99 publications

References 128 publications

Recurrent Implantation Failure: The Role of Anatomical Causes

Recurrent Implantation Failure: The Role of Anatomical Causes

A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis

Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up

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