Gene Therapy: Introduction to Biology and Techniques

Therapeutic options for adenomyosis: a review

BACKGROUND

To review the literature on various therapeutic modalities for uterine adenomyosis.

METHODS

Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy.

RESULTS

Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient's age and symptoms, desired fertility, site and extent of lesion and surgeon's skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial-myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2-3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired.

CONCLUSIONS

Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.

Benign myometrial conditions: leiomyomas and adenomyosis

Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for debilitating adenomyosis. Magnetic resonance imaging (MRI) is the most accurate modality for identifying leiomyomas and adenomyosis. T2-weighted sequences often are diagnostic. For leiomyomas, MRI reliably identifies their number, size, and location. These features help triage patients to appropriate therapy. For adenomyosis, MRI establishes the diagnosis in cases of equivocal or nondiagnostic ultrasounds. MRI also has been used to confirm an ultrasound diagnosis of adenomyosis when curative surgery is being considered. Intravenous gadolinium chelates are not necessary to make the diagnosis of either adenomyosis or leiomyomas, but it provides useful information about vascularity of lesions, a factor that may impact the type of treatment undertaken.