Current diagnostic and treatment strategies for adenomyosis

Adenomyosis is a common gynecological disorder that is characterized by the presence of ectopic endometrial glands and stroma embedded within the myometrium with adjacent smooth muscle hyperplasia. Menorrhagia, dysmenorrhea, metrorrhagia and dyspareunia are the presenting symptoms most often seen. The underlying etiology of adenomyosis is not fully known as yet. Therefore, the treatment of adenomyosis is also not yet optimal. Transvaginal sonography and magnetic resonance imaging are the two main tools for providing images that suggest adenomyosis, although a confirmed diagnosis can only be made after pathological examination of a hysterectomy specimen. The definitive treatment for adenomyosis is hysterectomy but, initially, less-invasive approaches should be tried, including oral contraceptives, progestins, danazol, gonadotropin-releasing hormone agonist, the levonorgestrel-releasing intrauterine system, myometrial excision and uterine artery embolization.