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Medical Treatment of Adenomyosis

  • Uterine Fibroids and Endometrial Lesions (T. Tulandi, Section Editor)
  • Published:
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Abstract

Purpose of Review

This article aims to offer a comprehensive review about current and investigational adenomyosis therapies and to address the gaps in our knowledge about the underlying pathogenic mechanisms to aid in the evolution of novel drugs.

Recent Findings

Despite the growing tendency to explore new drugs which target the underlying pathophysiology of adenomyosis rather than the traditional suppressive and symptomatic therapies, research directed to adenomyosis medical treatment is strongly limited.

Summary

Adenomyosis is a common benign gynecological disease for which the underlying pathophysiology is not entirely known. Despite it being silent in about one-third of patients, it presents with painful symptoms, bleeding, and infertility in the other two-thirds. Current imaging technique advancements, particularly TVS and MRI, have led to substantial improvements in adenomyosis diagnosis. Adenomyosis management should be customized to each patient, considering a variety of factors such as the patient’s age, complaints, wishes, and fertility plans. Currently, hysterectomy is the definitive therapy for adenomyosis. There is still inadequate evidence to justify the use of conservative surgical approaches in adenomyosis treatment: uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), magnetic resonance-guided high intensity focused ultrasound (MRgHIFU), hysteroscopic endometrial resection, or endo-myometrial ablation represent alternative therapeutic modalities. Adenomyosis medical treatment is still subject to debate as the majority of the currently used drug are off-label with no guidelines to follow for appropriate management, which usually targets symptomatic relief. By improving comprehension of the underlying pathogenesis of adenomyosis, new therapeutic options have become available and could be potential alternatives for the currently available drugs, which by majority act by influencing sex hormones.

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The first author is funded by a scholarship from the Egyptian Ministry of Higher Education outside the submitted work.

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  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Bahi Elbasueny, Maya Geerts, Catherine Allaire, Paul J. Yong & Mohamed A. Bedaiwy

  2. Department of Obstetrics and Gynaecology, British Columbia Women’s Hospital and Health Center, Faculty of Medicine, The University of British Columbia, D415-4500 Oak Street, BC V6H 3N1, Vancouver, Canada

    Bahi Elbasueny, Catherine Allaire, Paul J. Yong & Mohamed A. Bedaiwy

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

    Bahi Elbasueny

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Elbasueny, B., Geerts, M., Allaire, C. et al. Medical Treatment of Adenomyosis. Curr Obstet Gynecol Rep 11, 103–117 (2022). https://doi.org/10.1007/s13669-022-00325-8

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