X Deffieux1, H Fernandez. 1. Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 157, rue de la Porte-de-Trivaux, 92141 Clamart Cedex.
Abstract
OBJECTIVE: Adenomyosis is a relatively frequent disease of unknown origin, which is difficult to diagnose. Appropriate treatment for women who want to preserve or improve their fertility remains to be defined. METHODS: This review summarized the reports found on Medline database about pathophysiology, diagnosis and management of adenomyosis. RESULTS: Many pathophysiological factors may be involved in the occurrence of adenomyosis: immunological factors, estrogen sulfatase activity, tenascin which is a fibronectin inhibitor and angiogenesis and growth factors such as EGF, VEGF and GM-CSF. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. GnRH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progesterone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. CONCLUSION: Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.
OBJECTIVE:Adenomyosis is a relatively frequent disease of unknown origin, which is difficult to diagnose. Appropriate treatment for women who want to preserve or improve their fertility remains to be defined. METHODS: This review summarized the reports found on Medline database about pathophysiology, diagnosis and management of adenomyosis. RESULTS: Many pathophysiological factors may be involved in the occurrence of adenomyosis: immunological factors, estrogen sulfatase activity, tenascin which is a fibronectin inhibitor and angiogenesis and growth factors such as EGF, VEGF and GM-CSF. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. GnRH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progesterone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. CONCLUSION: Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.