Endometriosis is among the prevalent gynecological diseases and diagnosed in 10% of women of reproductive age. Endometriosis/adenomyosis is becoming increasingly a health-social problem, which is associated with severe clinical manifestations and recurrent disease which has a negative effect on quality of life, women ability to work and her reproductive function. This article presents modern approaches of drug therapy to treat severe forms of adenomyosis. We have reviewed recent major studies in the field of surgical treatment of this disease, analyzed the main stages of disease progress and the results of our surgeries. Here, we are presenting our own results of long-term post-operative hormonal therapy and complex medical treatment.

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.

Adenomyosis is a heterogeneous gynecologic disease with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhea. This article provides an overview of current knowledge about the methods of medical therapy for adenomyosis, based on the current understanding of the pathogenesis of the disease. We searched for scientific publications in the Cochrane Library, PubMed, and eLIBRARY databases using the keywords "adenomyosis", "medical treatment", and "hormonal therapy" from 2017 to 2022. We analyzed and summarized the scientific data accumulated to date on the methods of medical treatment of adenomyosis in women of reproductive age using gonadotropin-releasing hormone agonists, aromatase inhibitors, mifepristone, a levonorgestrel-releasing intrauterine device, combined oral contraceptives, and progestins.

Aim. To study the short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis who are in the perimenopausal age.Materials and Methods. The study included 18 patients with severe diffuse adenomyosis who underwent fertility-sparing excision of diffuse adenomyosis by means of Osada procedure. Efficiency of surgical treatment and subsequent drug therapy was evaluated at 12 and 24 months of follow-up by pelvic ultrasound examination. The frequency of adenomyosis symptoms and quality of life were assessed using the standard SF-36 questionnaire.Results. Recovery of the menstrual cycle, freedom from pain and anemia, and improved quality of life were documented in all cases (18/18), whereas onset of menopause occurred in half of the cases (9/18). In particular, all scales of the Physical Component Summary from SF-36 questionnaire were significantly improved at both follow-up time points.Conclusion. Organ-sparing excision of diffuse adenomyosis using Osada procedure is the option of choice and might represent an alternative to hysterectomy in women with perimenopausal age, in addition to those of earlier reproductive age.

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