Recent advances in understanding and managing adenomyosis

Abstract

Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the uterine myometrium and it is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified – International Federation of Gynecology and Obstetrics) classification of causes of abnormal uterine bleeding (AUB). Although it has always been considered the classic condition of multiparous women over 40 years old who have pain and heavy menstrual bleeding, diagnosed at hysterectomy, the epidemiological scenario has completely changed. Adenomyosis is increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging point of view, and the diagnosis remains difficult and unclear. A uniform and shared reporting system needs to be implemented in order to improve our understanding on imaging features, their relationship with pathogenic theories, and their importance in terms of clinical symptoms and response to treatment. In fact, adenomyosis pathogenesis remains elusive and not a single theory can explain all of the different phenotypes of the disease. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. Treatment requires a lifelong management plan as the disease has a negative impact on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome and has a high risk of miscarriage and obstetric complications.

Transcriptome sequencing of adenomyosis eutopic endometrium: A new insight into its pathophysiology

“…It is characterized by the presence of endometrial stroma and glands within the myometrium and its main clinical features include chronic pelvic pain, abnormal uterine bleeding, menorrhagia, dysmenorrhea, dyspareunia and infertility . In recent years, due to the advancement of imaging techniques such as transvaginal ultrasound scan (TVUS) and magnetic resonance imaging (MRI), substantial evidences suggest that adenomyosis may develop more often among younger women . To date, no novel compound is reported to develop for adenomyosis and clinical studies on the well‐conducted pharmacologic treatment are seldom reported .…”

“…1,[3][4][5] In recent years, due to the advancement of imaging techniques such as transvaginal ultrasound scan (TVUS) and magnetic resonance imaging (MRI), substantial evidences suggest that adenomyosis may develop more often among younger women. 6,7 To date, no novel compound is reported to develop for adenomyosis and clinical studies on the well-conducted pharmacologic treatment are seldom reported. 8 The most effective treeatments of adenomyosis are invasive surgeries such as hysterectomy, which is unacceptable for the patients who want to preserve their fertility.…”

Studies on a Levonorgestrel-Releasing Trade Plastic Device and on a Similar Polyurethane Foam Used as a Levonorgestrel Carrier

“…Hormonal IUD are used as a contraceptive method [21] or in the therapy of several conditions such as: heavy bleeding [22], women at risk for thrombocytopenia [23], endometrial hyperplasia [24], abnormal uterine bleeding in premenopause [25], endometriosis [26], and adenomyosis [27]. Before inserting an IUD, the patient should be investigated thoroughly because the symptoms caused by the IUD insertion may delay the diagnosis of serious illnesses.…”

Modern possibilities for the diagnosis of adenomyosis

“…диагностика основана на клинической картине и данных, полученных с помощью неинвазивных методов обследования [10]. К клиническим проявлениям аденомиоза относят различные варианты аномальных маточных кровотече-ний, болевой синдром, диспареунию, приводящие к достоверному снижению качества жизни [11][12][13][14][15]. Последние исследования показали, что аденомиозу подвержены и молодые женщины, у которых заболевание ассоциировано с бесплодием и невынашиванием беременности [13,16,17].…”

“…в настоящее время многие исследователи сходятся во мнении о необходимости создания единой систематической классификации аденомиоза, в том числе с помощью различных методов визуализации [12][13][14]. Поиск новых патогенетических механизмов развития заболевания с целью прогнозирования темпов, характера и выраженности клинических проявлений представляет научный и практический интерес.…”