Guideline No. 437: Diagnosis and Management of Adenomyosis

Dason, E. Shirin; Maxim, Madalina; Sanders, Ari; Papillon-Smith, Jessica; Ng, Danny Siu-Chun; Chan, Crystal C.Y.; Sobel, Mara

doi:10.1016/j.jogc.2023.04.008

Cited by 16 publications

(4 citation statements)

References 59 publications

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“…Uterine artery embolization (UAE) is a minimally invasive procedure where synthetic particles are injected into the uterine artery to obstruct vascular flow and facilitate tissue necrosis. This technique is used successfully for leiomyomas, and can be considered in patients with adenomyosis [15,19]. When performing UAE for adenomyosis, it is suggested that smaller particle sizes are used with an end point of near stasis in order to affect the endometrium and achieve desirable results; however, there is not a standardized protocol [15,[20][21][22][23].…”

Section: Uterine Artery Embolizationmentioning

confidence: 99%

Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Zeccola,

Allen

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes. Recent findings Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy. Summary This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.

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Section: Uterine Artery Embolizationmentioning

confidence: 99%

Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Zeccola,

Allen

2024

Current Opinion in Obstetrics &Amp; Gynecology

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“…Conservative approaches may involve analgesics, hormonal therapies, or intrauterine devices releasing progestins. In cases in which medical management proves inadequate or for those who are past childbearing age, more aggressive interventions such as uterine artery embolization or surgical options like hysterectomy may be considered [45].…”

Section: Adenomyosis: Aub-amentioning

confidence: 99%

Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management

Viganò,

Smedile,

Cazzella

et al. 2024

Diagnostics

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Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women’s health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.

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“…Adenomyosis is a disease characterized by the presence of endometrial tissue (glands and stroma) in the context of the myometrium. It is much more common in pluripares and in women undergoing surgery of the uterus [60]. Generally, women complain of extremely severe pain during menstruation and suffer from abdominal cramps, abundant and irregular menstruation, fertility problems and adverse pregnancy outcomes [61,62].…”

Section: Adenomyosismentioning

confidence: 99%

Magnetic Resonance Roadmap in Detecting and Staging Endometriosis: Usual and Unusual Localizations

Piccolo,

Cea,

Sbarra

et al. 2023

Applied Sciences

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Endometriosis is a chronic condition characterized by the presence of abnormal endometrial tissue outside the uterus. These misplaced cells are responsible for inflammation, symptoms, scar tissue and adhesions. Endometriosis manifests mainly in three patterns: superficial peritoneal lesions (SUP), ovarian endometriomas (OMA) and deep infiltrating endometriosis (DIE). It also exhibits atypical and extremely rare localization. The updated 2022 guidelines of the ESHRE recommend using both ultrasound and magnetic resonance imaging (MRI) as first-line diagnostic tests. Currently, MRI provides a more complete view of the pelvis anatomy. The aim of our review is to provide radiologists with a “map” that can help them in reporting pelvic MRI scans in patients with endometriosis. We will illustrate the usual and unusual localizations of endometriosis (categorized into compartments) using post-operative imaging, and we will focus on the role of MRI, the main sequences and the use of contrast agents.

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Guideline No. 437: Diagnosis and Management of Adenomyosis

Cited by 16 publications

References 59 publications

Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management

Magnetic Resonance Roadmap in Detecting and Staging Endometriosis: Usual and Unusual Localizations

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