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Human Reproduction Update, Vol.4, No.4 pp.323-336, 1998
© European Society of Human Reproduction and Embryology 1998; all rights reserved

Surgical and medical treatment of adenomyosis

C Wood

Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia

Abstract

The treatment of adenomyosis has been limited by the difficulty and delay associated with the diagnosis, often not until after hysterectomy. Magnetic resonance imaging, high resolution vaginal ultrasound and uterine biopsy have improved early detection of adenomyosis. Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in >50% of patients, although follow-up has been restricted to 3 years. Hysterectomy will still be necessary in severe cases of adenomyosis. Early diagnosis may improve treatment. Investigations are indicated in women with menstrual pain or menorrhagia not responding to drug therapy.

Key words: adenomyosis/conservative surgery/drug treatment


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