Adenomyosis and Abnormal Uterine Bleeding (AUB-A)—Pathogenesis, diagnosis, and management

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 40; pp. 68 - 81
• Main Author: Abbott, Jason A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2017
• Subjects: adenomyosis; Adenomyosis - complications; Adenomyosis - diagnosis; Adenomyosis - therapy; Adult; AUB-A; conservative uterine surgery; Female; Fertility; Humans; Hysterectomy - adverse effects; Magnetic Resonance Imaging; Obstetrics and Gynecology; Parity; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors; Ultrasonography; Uterine Hemorrhage - diagnosis; Uterine Hemorrhage - etiology; Uterine Hemorrhage - therapy; uterine junctional zone; uterine junctional zone; AUB-A; conservative uterine surgery; adenomyosis; Adenomyosis
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2016.09.006

The complex pathogenesis and variable presentation of adenomyosis make it one of the most difficult of the FIGO PALM-COIEN abnormal uterine bleeding group to diagnose and treat. Basic clinical parameters such as prevalence are difficult to accurately assess because histological confirmation is usually employed; however, because of the access to and accuracy and utilization of transvaginal ultrasound and other advanced imaging techniques such as MRI, noninvasive diagnosis is recognized to be highly accurate. The clinical symptoms of pain, abnormal uterine bleeding, and subfertility are the primary presentations of adenomyosis with increasing data supporting a substantial role of this disease in reducing fecundity and interfering with assisted reproductive interventions. Treatments have been aimed at managing symptoms and improving fertility options. Management by hysterectomy is not always desired by women, and with many women having children in their fourth and even fifth decades, it is often not reasonable to consider this radical option. •Damage to the uterine junctional zone is a primary contributor to adenomyosis.•Diagnosis may be reliably made by well-performed ultrasonography or MRI.•Medical managements need to be useable for a prolonged duration, with the LNG-IUD being the best option to date.•Conservative surgical management is feasible but requires high technical skill.•Interventional sonography and radiological techniques are emerging and beneficial alternatives to surgery.