Surgical and medical treatment of adenomyosis

The treatment of adenomyosis has been limited by the difficultyand delay associated with the diagnosis, often not until afterhysterectomy. Magnetic resonance imaging, high resolution vaginalultrasound and uterine biopsy have improved early detectionof adenomyosis. Drug therapy may be effective in controllingsymptoms but the frequent coexistence of endometriosis and thelack of controlled studies make their efficacy difficult toquantify. Conservative surgery involving endomyometrial ablation,laparoscopic myometrial electrocoagulation or excision has provento be effective in >50% of patients, although follow-up hasbeen restricted to 3 years. Hysterectomy will still be necessaryin severe cases of adenomyosis. Early diagnosis may improvetreatment. Investigations are indicated in women with menstrualpain or menorrhagia not responding to drug therapy.