ABSTRACT

Adenomyosis – diagnosis and current treatment methods

The essence of the contemporary approach to the disorder of uterine myometrium referred to as adenomyosis is analysis of a close contact between two extremely morphologically and functionally diverse tissues, namely the endometrium and myometrium. Phenomena of immunology, genetics and molecular biology associated with these tissues are the essence of this disorder. At present, owing to the spectacular development of non-invasive imaging techniques (ultrasound), it is possible to perform antemortem diagnosis of adenomyosis. Imaging diagnosis may be supplemented with MRI, establishing a sound foundation for a new anatomical approach to the endometrium-myometrium interface. While histological diagnosis does not present a difficulty, the reproducibility of imaging findings between different centres leads to diagnostic discrepancies. Therefore, a correct diagnosis should be integrative, combining information about risk factors, the spectrum of clinical symptoms, clinical examination results and imaging tests. The histopathological appearance of adenomyosis involves an endometrial component, i.e. the presence of glands and a stroma with eutopic endometrial features inside the myometrium, and a muscle component, in the form of smooth muscle fibres. Sonography, especially transvaginal, represents the first-line diagnostic technique and is supplemented by MRI, which allows for imaging the zonal composition of the uterus and, in the case of adenomyosis, shows pathology and distortions of this zonal structure. Diagnosis and therapy benefit from endoscopic techniques (hysteroscopy and laparoscopy). Conservative treatment should be performed in patients with infertility in whom adenomyosis has been established as a causative factor, e.g. in recurrent failures of in vitro embryo implantation. Pharmacological treatment is administered to women who do not accept surgery as an invasive modality. They receive hormonal treatment, starting with GnRH analogues, oestroprogestagens or progestogens. The effectiveness of hormonal treatment depends on the presence of oestrogen and progesterone receptors in particular zones. Intrauterine administration of hormonal agents via intrauterine devices is also recommended, e.g. in cases of abnormal uterine bleeding caused by adenomyosis. Endometrial ablation may be an alternative to IUD in selected cases as a radical way to relieve patients of abnormal uterine bleeding.

Piśmiennictwo

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