The purpose of this review is to summarize and highlight recent critical advances in the diagnosis, classification, and management of adenomyosis.
Recent studies have clarified the specific mechanism through which adenomyotic lesions invade the underlying myometrium by epithelial–mesenchymal transition. Correlation studies using diagnostic MRI also strongly support the hypothesis of a different pathogenesis between the inner and outer myometrium forms of adenomyosis. Given advances in diagnostic imaging, several international organizations have also highlighted the importance of classification systems for adenomyosis. Finally, selective progesterone receptor modulators and gonadotropin-releasing hormone antagonists have demonstrated significant promise for treating pelvic pain and bleeding associated with adenomyosis, whereas novel fertility-preserving surgical techniques have been introduced to excise diffuse adenomyotic pathology while maintaining adequate uterine integrity.
Recent attempts at a uniform and reproducible classification system likely represent the first step for the development of a staging system for adenomyosis that can be correlated with the severity of clinical symptoms and promote an individualized therapeutic approach. Simultaneously, further insights into the etiology and pathogenesis as outlined in this review may also help in the development of targeted medical therapies.
aDepartment of Obstetrics and Gynaecology, Division of Reproductive Endocrinology and Infertility, The University of British Columbia
bDepartment of Obstetrics and Gynaecology, The Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
Correspondence to Mohamed A. Bedaiwy, MD, PhD, FACOG, FRCSC, Department of Obstetrics & Gynecology, The University of British Columbia, D415A-4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada. Tel: +1 604 875 2000 ext 4310; fax: +1 604 875 2725; e-mail: firstname.lastname@example.org