The response of adenomyosis to endometrial ablation/resection

Operative hysteroscopy is a relatively new technique that hassignificantly improved the diagnosis and therapy of abnormaluterine bleeding. At first, the success of operative hysteroscopyin controlling this bleeding seemed extremely high but, withlong-term follow-up, a significant failure rate became evidentrequiring a repeat hysteroscopic procedure or a hysterectomy.Deep adenomyosis is a major cause of these failures. This paperdescribes three operative ablation techniques and relates manyof their failures to deep adenomyosis. The definition and pathophysiologyof adenomyosis are also explored. The possibility of delayingthe diagnosis of endometrial cancer under an ablation scan isdiscussed. Ultimately the depth of adenomyosis seems to correlatewith the outcome of endometrial ablation or resection. Patientswithout or with only minimal endometrial penetration of <2.5mm (superficial adenomyosis) have good results from the ablation.Patients with deep endometrial penetration of >2.5 mm (deepadenomyosis) usually have persistent problems and should beoffered hysterectomy over repeat ablation. Magnetic resonanceimaging or ultrasound may be an appropriate pre-operative screeningtool to determine the depth of adenomyosis.