2. PATHOGENESIS
NOT YET KNOWN , but the two major theories are
that it either develops from endomyometrial
invagination of the endometrium or de novo from
mullerian rests
Junctional zone of the myometrium (ultrastructural changes and
differential growth factor expression).
Gonadal steroid hormones (estrogen and progesterone).
Pituitary protein hormones, including prolactin and follicle
stimulating hormone (FSH) .
These may also play a key role in the disease
3. TREATMENT
The only guaranteed treatment for adenomyosis is total
hysterectomy
• ovarian conservation can be employed
Hormonal manipulation with progestins
:
• Levonorgestrel releasing intrauterine
contraception [IUC]) (24% reduction in
thickness of junctional zone after 6
months)
• Gonadotropin releasing hormone
analogs.
• Aromatase inhibitors.
May be effective for reducing
Menorrhagia and dysmenorrhea.
N.B
Enlargement of the uterus
and recurrence of symptoms are usually
documented within six months after
cessation of hormonal therapy.
4. Estrogen progestin
Contraceptives
• Efficacy not known.
• May relief pain with continuous
use.
Conservative surgery
• Endomyometrial ablation or
resection.
• Laparoscopic Myometrial
electrocoagulation.
• Excision of adenomyosis
Conservative surgery +
GnRH medical therapy Better
for syptom control than surgery
alone.
5. Uterine artery embolization (UAE)
• Successful in resolving symptoms
in some women.
• Decrease uterine volume
significantly.
Hysterectomy still appears to be the treatment of choice for women
with significant symptoms who have completed childbearing.
While for young women with extensive adenomyosis, who
decline hysterectomy, exploration of alternative treatments for
symptomatic relief
MRI guided focused ultrasound
surgery
• limited experience with treatment
outcomes
