Adenomyosis Pathophysiology, Diagnostic Advances, and Therapeutic Options - PubMed

21 hours ago

Adenomyosis is a nonmalignant uterine disorder with ectopic endometrium in the myometrium, causing symptoms like abnormal bleeding, pain, and subfertility.
It was once thought to affect multiparous women over 40, but imaging advances have identified it in younger reproductive-aged patients.
Pathogenesis involves sex steroid imbalance, inflammation, fibrosis, neuroangiogenesis, and stem cell-mediated mechanisms.
Clinical presentation varies from asymptomatic to severe pain and bleeding, often coexisting with leiomyomas and endometriosis.
Diagnosis is challenging due to lack of histologic consensus, but improved imaging techniques have enhanced noninvasive detection.
Medical management includes progestins, levonorgestrel IUS, GnRH analogs/antagonists, and emerging agents, with efficacy extrapolated from related conditions.
Interventional/surgical options (e.g., uterine artery embolization, ablation, adenomyomectomy) offer symptom relief and uterine preservation, but recurrence and fertility outcomes are unclear.
Adenomyosis imposes a significant physical, psychological, and socioeconomic burden, necessitating disease-specific trials and standardized criteria for optimized care.

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