Options to manage adenomyosis that do not involve surgery

What is it about?

Purpose of review: Adenomyosis is a condition where endometrium-like tissue spreads within the myometrium. Although its prevalence in the general population is not exactly known, its clinical manifestations are well established and include pelvic pain, dysmenorrhea (painful periods), heavy menstrual bleeding and subfertility [1] . Adenomyosis often coexists with other gynaecological conditions, such as endometriosis or fibroids, and may cloud the clinical presentation [2] . The aim of this article is to review current noninterventional, nonsurgical management modalities and wherever possible offer information that allows women to make safe and informed choices regarding their treatment options. Recent findings: Recent studies support that medical strategies, including the Mirena coil, Dienogest and GnRH antagonists, are efficient in improving adenomyosis-associated symptoms. High-quality evidence is scarce and is needed to properly counsel women with this condition. Future research should prioritize overall pain, menstrual bleeding, quality of life and live birth as primary outcomes and assess women with different grades of adenomyosis. Summary: This review provides the most current evidence with regards to the nonsurgical management of adenomyosis. In light of the paucity and low quality of existing data, high-quality trials are needed to definitely determine the impact of conservative and medical treatment on the clinical management of adenomyosis.

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Why is it important?

This review highlights the options for conservative medical management of adenomyosis-related symptoms. The usage of GnRH antagonists are gaining momentum in the conservative medical management with further research required for promising novel immunomodulating agents for this enigmatic condition. This avoids the morbidity of radiological interventions and surgical approaches that may also compromise further fertility potential of reproductive aged women with adenomyosis. This provides the patient with a holistic approach for symptomatic relief and quality-of-life improvement where surgery is not desired or suitable.