The response of adenomyosis to endometrial ablation/resection

Abstract

Operative hysteroscopy is a relatively new technique that has significantly improved the diagnosis and therapy of abnormal uterine bleeding. At first, the success of operative hysteroscopy in controlling this bleeding seemed extremely high but, with long-term follow-up, a significant failure rate became evident requiring a repeat hysteroscopic procedure or a hysterectomy. Deep adenomyosis is a major cause of these failures. This paper describes three operative ablation techniques and relates many of their failures to deep adenomyosis. The definition and pathophysiology of adenomyosis are also explored. The possibility of delaying the diagnosis of endometrial cancer under an ablation scar is discussed. Ultimately the depth of adenomyosis seems to correlate with the outcome of endometrial ablation or resection. Patients without or with only minimal endometrial penetration of <2.5 mm (superficial adenomyosis) have good results from the ablation. Patients with deep endometrial penetration of >2.5 mm (deep adenomyosis) usually have persistent problems and should be offered hysterectomy over repeat ablation. Magnetic resonance imaging or ultrasound may be an appropriate pre-operative screening tool to determine the depth of ademomyosis.

Uterine artery embolization for adenomyosis without fibroids

“…In endometrial ablation, the success rate was high at first, but with longterm follow-up a significant failure rate became evident, particularly, in deep adenomyosis. 16 Other conservative surgery has proven to be effective in more than 50% of patients, although no long-term follow-up is currently available. 3 Recently, UAE has been reported as being successful in managing symptoms caused by uterine myomas.…”

Uterine Artery Embolization to Treat Uterine Adenomyosis with or without Uterine Leiomyomata: Results of Symptom Control and Health-Related Quality of Life 40 Months after Treatment

“…Uterine adenomyosis, on the other hand, usually requires hysterectomy because of poor results of hormone treatment or endometrial ablation [12]. Several studies have reported symptomatic improvement after UAE in women with uterine leiomyomata and uterine adenomyosis, so investigators have proposed UAE for managing symptomatic uterine adenomyosis.…”

Ablación endometrial histeroscópica como tratamiento definitivo para el sangrado uterino anormal

“…Esta diferencia no fue estadísticamente significativa al comparar con aquellas pacientes que no necesitaron segundo procedimiento por SUA, en contraste con otros estudios que proponen a la adenomiosis como causa importante del fracaso de la ablación endometrial histeroscópica (10).…”

“…También se describe en la literatura que la adenomiosis sería una causa importante de falla de la técnica, principalmente aquella que penetra más de 2,5 mm en el espesor miometrial, sin embargo no es considerada una contraindicación propiamente tal (10).…”

“…Existen distintas técnicas para realizar este procedimiento, como la ablacion endometrial guiada por histeroscopía o de primera generación, que incluye la resección endometrial transcervical, el uso de rollerball y ablación láser, que requieren de medios de distensión gaseosos o líquidos (4,(7)(8)(9)(10)(11). Los métodos de segunda generación incluyen 5 méto-dos ablativos: balón térmico, hidrotermia, energía microondas, electrocirugía de radiofrecuencia, y crioterapia (6,9).…”