ADENOMYOSIS

PRESENCE OF HETEROTOPIC ENDOMETRIAL GLANDS AND

STROMA WITHIN THE MYOMETRIUM

PREVALENCE BETWEEN 5-70%

WOMEN BETWEEN 40-50 YEARS

FOCAL OR DIFFUSE
JUVENILE CYSTIC

ABNORMAL UTERINE BLEEDING

DYSMENORRHEA
ADENOMYOSIS INFERTILITY
CHRONIC PELVIC PAIN

HYSTOPATHOLOGY OF UTERUS

TRANSVAGINAL ULTRASONOGRAPHY
MAGNETIC RESONANCE IMAGING

MANAGEMENT :
NON-SURGERY ; SURGERY

Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016

 DIAGNOSIS

Vidal, IS., Soares, LS., Dutra, CA., Javino, MJ., Goncalves, AK., Cobucci, RN. Adenomyosis in An 18-Year-Old Adolescent: A Case Report. Obstet Gynecol Cases Rev 2018;5(121)
Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016
Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016
Li, JJ., Chung, JP., Wang, S., Li, TC., Duan, H. The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility
 MANAGEMENT

MANAGEMENT

MEDICAL
(SYMPTOMATIC SURGICAL
TREATMENT) (CYTOREDUCTIVE TREATMENT)
PRESERVING FERTILITY ± PRESERVING FERTILITY OR
(REPRODUCTIVE AGE, FAILURE MEDICAL TREATMENT
ADOLESCENT)

NSAID
TO CREATE A
s HYPOESTROGENIC, COMPLETE OR
GnRH AGONIST, ORAL
CONTRACEPTIVE, HYPERANDROGENIC, OR SPARING;
HYPOPROGESTOGENIC
PROGESTIN, DANAZOL, ENVIRONMENT WITH RESECTION
SERMs, SPRMs, AROMATASE SUPPRESSION OF ABLATION,
INHIBITOR ENDOMETRIAL CELL
PROLIFERATION
EMBOLIZATION

FACTORS THAT INFLUENCE THE CHOICE OF TREATMENT :

TO REMOVE OR PRESERVE THE UTERUS (FERTILITY CONSERN), SYMPTOM, EXTENT OF
ADENOMYOSIS, COEXISTING PELVIC DISEASE

Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016

Tsui, KH., Lee, Wl., Chen, CY., Sheu, BC., Yen, MS., Chang, TC., et al. Medical Treatment for Adenomyosis and/or Adenomyoma. Taiwanese Journal of Obstetrics and Gynecology 2014;53:459-465
 MEDICAL

OBJECTIVE
OF
MEDICAL INHIBITION OF
TREATMEN
T OVULATION
SYMPTOM RELIEF

INCREASE FERTILITY

Tsui, KH., Lee, Wl., Chen, CY., Sheu, BC., Yen, MS., Chang, TC., et al. Medical Treatment for Adenomyosis and/or Adenomyoma. Taiwanese Journal of
Obstetrics and Gynecology 2014;53:459-465
 SURGICAL

HYSTERECTOM
Y
DEFINITIVE TREATMENT
RISK OF BLADDER INJURY AND
PERSISTENT PELVIC PAIN

DON’T DESIRE A FUTURE

PREGNANCY

LAPAROSCOPICALLY OR
VAGINALLY

Li, JJ., Chung, JP., Wang, S., Li, TC., Duan, H. The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility
Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016
 UTERINE SPARING CONSERVATIVE SURGERY
• INDICATION : WELL-DEFINED ADENOMYOMA MORE THAN 5 CM AND
RECURRENT MISCARRIAGE OR RECURRENT IMPLANTATION FAILURE AFTER
IVF; FOCAL OR DIFFUSE ADENOMYOSIS
• LAPAROTOMY OR LAPAROSCOPY
• RISK : UTERINE RUPTURE, ASHERMAN SYNDROME, UTERINE DEFORMITY,
REDUCED UTERINE CAPACITY

HYSTEROSCOPIC SURGERY
• HYSTEROSCOPIC ADENOMYOMECTOMY
• ADENOMYOMA IS <5 CM OR WHEN IT PROTRUDES INTO THE UTERINE
CAVITY
• USG GUIDANCE
• A MINIMAL SAFETY MARGIN OF 5MM BETWEEN THE SEROSA AND
ADENOMYOMA IS CONSIDERED NECESSARY TO AVOID THE RISK OF
UTERINE PERFORATION
• PRETREATMENT WITH 3-MONTH COURSE OF GNRH AGONIST TO REDUCE
VASCULARITY

Li, JJ., Chung, JP., Wang, S., Li, TC., Duan, H. The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility
Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016
Grimbizis, GF., Mikos, T., Tarlatzis, B. Uterus-sparing Operative Treatment for Adenomyosis. Fertility Sterility 2014;101:472-87
 • ADENOMYOMECTOMY (OPEN OR LAPAROSCOPY) :
COMPLETE FOR LOCAL ADENOMYOSIS OR SELECTED DIFFUSE
ADENOMYOSIS CASE WITH UTERINE
EXCISION RECONSTRUCTION
• CYSTECTOMY : FOR CYSTIC FOCAL ADENOMYOSIS

CYTOREDUCTIV • FOR DIFFUSE ADENOMYOSIS

E SURGERY • PARTIAL ADENOMYOMECTOMY

NONEXCISIONAL • USED IN INTERVENTIONS WHERE REMOVAL OF

TECHNIQUES ADENOMYOTIC TISSUE IS NOT INCLUDED

Grimbizis, GF., Mikos, T., Tarlatzis, B. Uterus-sparing Operative Treatment for Adenomyosis. Fertility Sterility 2014;101:472-87
 UTERINE ARTERY EMBOLIZATION (UAE)
• IMPROVE DYSMENORRHEA AND MENORRHAGIA
• FUTURE FERTILITY RATES AND OBSTETRICS
OUTCOMES ARE UNKNOWN

ENDOMETRIAL ABLATION OR RESECTION

• LAPAROSCOPIC OR HYSTEROSCOPIC
• IMPROVE DYSMENORRHEA AND MENORRHAGIA
• ENDOMETRIAL ABLATION >3 MM IS
CONTRAINDICATED DUE TO THE PRESENCE OF
SIGNIFICANT MYOMETRIAL ARTERIES
APPROXIMATELY 5 MM DEEP WITHIN THE
MYOMETRIUM

Li, JJ., Chung, JP., Wang, S., Li, TC., Duan, H. The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility
Habiba, M., Benagiano, G. Uterine Adenomyosis. Springer International Publishing 2016
Himpunan Endokrinologi-Reproduksi dan Fertilitas Indonesia Perkumpulan Obstetri dan Ginekologi Indonesia. Konsensus Tatalaksana Nyeri Haid pada
Endometriosis. HIFERI POGI 2013c
THANK YOU