ADENOMIOSIS :

UPDATE 2008

JULIANTO WITJAKSONO

DIVISI IMUNOENDOKRONOLGI REPRODUKSI

DEPARTEMEN OBSTETRI DAN GINEKOLOGI
FAKULTAS KEDOKTERAN UNIVERSITAS INDONESIA
RUMAH SAKIT DR CIPTO MANGUNKUSUMO
JAKARTA
 Definition

• A benign uterine condition in which endometrial glands

and stroma are found deep in the myometrium
• A benign disease of the uterus characterized by ectopic
endometrial glands and stroma within the myometrium
• It is associated with myometrial hypertrophy and may be
either diffuse or focal
• = myometrial endometriosis
 Prevalences

• Occurs primarily in women in 25 ～ 45s

• Increase significantly
• Range from 1 ～ 50%
– General population 1 ～ 2 %
– Infertile women 30 ～ 50 %
 ADENOMYOSIS

Risk Factors
• Multi-parous
• Previously history of
– Endometrial hyperplasia
– Spontaneous abortion
– Dilatation and curratage
• Neither on the evidence of
– Caesarean section
– Myomectomy
– Endometrial ablation
(OR 2.7; 1.3-5.8)
(OR 1.6; 1.0-2.4)
(OR 2.1; 1.1-3.8)
(OR 1.19; 0.95-1.50)
(OR 1.12; 0.68-1.85)
(OR 3.62; 0.71-14.83)

1. Parazzini et al. Hum Reprod 1997;12:1275-1279

2. Panganamamula et al. Obstet Gynecol 2004;104:1034-1038
 Diagnosis
• Medical History
• Pelvic examinations
• Serum markers ： CA-125
• Imaging Diagnostic
– Ultrasonography
– CT-scan
– MRI
• Biopsy of uterus(at diagnostic hysteroscopy or laparoscopy procedure)
 THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
CLINICAL SYMPTOMS

• Asymptomatic adenomyosis occurs in 30-45% parous

women in reproductive age
• Symptomatic adenomyosis
– Classic symptoms (secondary dysmenorrhea, abnormal
uterine bleeding)
– Most common physical sign particularly tender during
menstruation
 ETIOLOGY OF ADENOMYOSIS

Four primary theories ：

– Heredity (transformation)
– Trauma (mechanical injuries)
– Hyper-estrogenemia (food, diseases, medical treatment
– Viral transmission (?)
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Probe set Gene ID Gene description A/endo A/myo UF/myo A/UF myo/endo
239336_at THBS1 Thrombospondin 1 10.55 4.96 nsc nsc nsc
Metastasis-associated lung adenocarcinoma transcript 1
224559_at MALAT1 10.44 9.5 7.68 nsc nsc
(non-coding RNA)
230068_s_at PEG3 Paternally expressed 3 6.83 7.2 3.39 2.12 nsc
212382_at TCF4 Transcription factor 4 6.24 3.66 nsc 3.37 nsc
1558019_at DST Dystonin 6.11 6.57 3.87 nsc nsc
V-maf musculoaponeurotic fibrosarcoma oncogene
229327_s_at MAF 5.54 5.77 2.36 2.45 nsc
homolog (avian)
201868_s_at TBL1X Transducin (ß)-like 1X-linked 4.86 6.73 6.87 nsc nsc
230214_at MRVI1 Murine retrovirus integration site-1 homolog 4.58 2.52 3.39 nsc nsc
Non-metastatic cells 7, protein expressed in (nucleoside-
227556_at NME7 4.54 3.22 nsc nsc nsc
diphosphate kinase)
217875_s_at TMEPAI Transmembrane, prostate androgen-induced RNA 4.39 2.33 nsc nsc nsc
231592_at XIST X (inactive)-specific transcript 4.08 3.85 nsc nsc nsc
219534_x_at CDKN1C Cyclin-dependent kinase inhibitor 1C (p57, Kip2) 4.08 2.15 nsc 2.04 nsc
201416_at SOX4 SRY (sex-determining region Y)-box 4 3.95 4.31 2.66 nsc nsc
205187_at SMAD5 SMAD, mothers against DPP homolog 5 (Drosophila) 3.92 3.63 2.82 nsc nsc
213446_s_at IQGAP1 IQ motif containing GTPase activating protein 1 3.7 2.06 3.99 nsc nsc
244774_at PHACTR2 Phosphatase and actin regulator 2 3.69 2.34 nsc nsc nsc
228588_s_at UBE2B Ubiquitin-conjugating enzyme E2B (RAD6 homolog) 3.61 4.57 2.27 2.01 nsc
229733_s_at CBX6 Chromobox homolog 6 3.46 3.43 nsc 2.36 nsc
237333_at SYNC1 Retinoblastoma-binding protein 4 3.43 2.1 nsc nsc nsc
227897_at RAP2B RAP2B, member of RAS oncogene family 3.38 5.08 3.4 nsc nsc
206929_s_at NFIC Nuclear factor I/C (CCAAT-binding transcription factor) 3.37 2.22 nsc nsc nsc
229704_at APRIN Androgen-induced proliferation inhibitor 3.37 4.97 2.36 2.11 nsc
230618_s_at BAT2D1 BAT2 domain containing 1 3.36 4.08 2.56 nsc nsc
213067_at MYH10 Myosin, heavy polypeptide 10, non-muscle 3.27 2.24 nsc nsc nsc
1565566_a_a
t
STX7 Syntaxin 7 3.25 3.01 nsc 2.33 nsc
223136_at AIG1 Androgen-induced 1 0.34 0.27 0.35 nsc nsc
203895_at PLCB4 Phospholipase C, ß4 0.34 0.23 0.19 nsc nsc
205442_at MFAP3L Microfibrillar-associated protein 3-like 0.34 0.26 0.29 nsc nsc
229839_at SCARA5 Hypothetical protein MGC45780 0.34 0.19 0.21 nsc nsc
219274_at TSPAN12 Transmembrane 4 superfamily member 12 0.33 0.3 0.3 nsc nsc
218326_s_at LGR4 Leucine-rich repeat-containing G protein-coupled receptor 4 0.33 0.25 0.29 nsc nsc
213222_at PLCB1 Phospholipase C, ß1 (phosphoinositide-specific) 0.33 0.43 nsc nsc nsc
205992_s_at IL15 Interleukin 15 0.32 0.38 nsc nsc nsc
224516_s_at CXXC5 CXXC finger 5 0.31 0.47 nsc nsc nsc
Methylenetetrahydrofolate dehydrogenase (NADP+
201761_at MTHFD2 0.3 0.31 0.48 nsc nsc
dependent) 2, methenyltetrahydrofolate cyclohydrolase
230560_at STXBP6 Syntaxin-binding protein 6 (amisyn) 0.3 0.36 0.3 nsc nsc
201212_at LGMN Legumain 0.3 0.41 nsc 0.48 nsc
223168_at RHOU ras homolog gene family, member U 0.28 0.45 nsc nsc nsc
231897_at LTB4DH Leukotriene B4 12 hydroxydehydrogenase 0.28 0.4 0.48 nsc nsc
210427_x_at ANXA2 Annexin A2 0.28 0.48 nsc nsc nsc
208308_s_at GPI Glucose phosphate isomerase 0.27 0.41 nsc nsc nsc
214687_x_at ALDOA Aldolase A, fructose-bisphosphate 0.27 0.34 0.45 nsc nsc
200736_s_at GPX1 Glutathione peroxidase 1 0.27 0.49 nsc nsc nsc
200650_s_at LDHA Lactate dehydrogenase A 0.26 0.49 nsc nsc nsc
1560587_s_a
t
PRDX5 Peroxiredoxin 5 0.23 0.43 nsc nsc nsc
205081_at CRIP1 Cysteine-rich protein 1 (intestinal) 0.19 0.37 nsc nsc nsc
212038_s_at VDAC1 Voltage-dependent anion channel 1 0.17 0.33 nsc 0.45 nsc
211745_x_at HBA1 Haemoglobin, 1 0.15 0.25 nsc nsc nsc
214414_x_at HBA2 Haemoglobin, 2 0.1 0.16 nsc nsc nsc
1565162_s_a
MGST1 Microsomal glutathione S-transferase 1 0.08 0.23 0.15 nsc nsc
 Probe set Gene ID Gene description A/endo A/myo UF/myo A/UF myo/endo
239336_at THBS1 Thrombospondin 1 10.55 4.96 nsc nsc nsc
Metastasis-associated lung adenocarcinoma transcript 1
224559_at MALAT1 10.44 9.5 7.68 nsc nsc
(non-coding RNA)

GROWTH GENOMIC CONTROLLED ANALYSIS

230068_s_at PEG3 Paternally expressed 3 6.83 7.2 3.39 2.12 nsc
212382_at TCF4 Transcription factor 4 6.24 3.66 nsc 3.37 nsc
1558019_at DST Dystonin 6.11 6.57 3.87 nsc nsc
V-maf musculoaponeurotic fibrosarcoma oncogene

PATHOGENESIS OF ADENOMYOSIS
229327_s_at MAF 5.54 5.77 2.36 2.45 nsc
homolog (avian)
201868_s_at TBL1X Transducin (ß)-like 1X-linked 4.86 6.73 6.87 nsc nsc
230214_at MRVI1 Murine retrovirus integration site-1 homolog 4.58 2.52 3.39 nsc nsc
Non-metastatic cells 7, protein expressed in (nucleoside-
227556_at NME7 4.54 3.22 nsc nsc nsc
diphosphate kinase)
217875_s_at TMEPAI Transmembrane, prostate androgen-induced RNA 4.39 2.33 nsc nsc nsc
Probe set Gene ID Gene description 231592_at XIST
219534_x_at CDKN1C
A/endo
X (inactive)-specific transcriptA/myo UF/myo A/UF
Cyclin-dependent kinase inhibitor 1C (p57, Kip2)
4.08
4.08
myo/endo
3.85
2.15
nsc
nsc
nsc
2.04
nsc
nsc
239336_at THBS1 Thrombospondin 1 201416_at SOX4 10.55
SRY (sex-determining 4.964
region Y)-box nsc nsc3.95 nsc
4.31 2.66 nsc nsc
205187_at SMAD5 SMAD, mothers against DPP homolog 5 (Drosophila) 3.92 3.63 2.82 nsc nsc
Metastasis-associated lung adenocarcinoma transcript 1
213446_s_at IQGAP1 IQ motif containing GTPase activating protein 1 3.7 2.06 3.99 nsc nsc
224559_at MALAT1 244774_at PHACTR2 Phosphatase and 10.44
actin regulator 9.5
2 7.68 nsc3.69 nsc
2.34 nsc nsc nsc
(non-coding RNA) 228588_s_at UBE2B Ubiquitin-conjugating enzyme E2B (RAD6 homolog) 3.61 4.57 2.27 2.01 nsc
230068_s_at PEG3 Paternally expressed 3 229733_s_at CBX6
237333_at SYNC1
Chromobox homolog 6.83 6
Retinoblastoma-binding protein 4
7.2 3.39 2.123.46
3.43
nsc
3.43
2.1
nsc
nsc
2.36
nsc
nsc
nsc
212382_at TCF4 Transcription factor 4 227897_at RAP2B RAP2B, member of 6.24
RAS oncogene 3.66family nsc 3.373.38 nsc
5.08 3.4 nsc nsc
206929_s_at NFIC Nuclear factor I/C (CCAAT-binding transcription factor) 3.37 2.22 nsc nsc nsc
1558019_at DST Dystonin 229704_at APRIN Androgen-induced6.11 proliferation6.57
inhibitor 3.87 nsc3.37 nsc
4.97 2.36 2.11 nsc
230618_s_at BAT2D1 BAT2 domain containing 1 3.36 4.08 2.56 nsc nsc
V-maf musculoaponeurotic fibrosarcoma oncogene Myosin, heavy polypeptide 10,5.77
non-muscle 2.36
229327_s_at MAF 213067_at
1565566_a_a
MYH10
5.54 2.45 3.27
nsc
2.24 nsc nsc nsc

homolog (avian) t
223136_at
STX7
AIG1
Syntaxin 7
Androgen-induced 1
3.25
0.34
3.01
0.27
nsc
0.35
2.33
nsc
nsc
nsc
201868_s_at TBL1X Transducin (ß)-like 1X-linked 203895_at PLCB4 Phospholipase C,4.86ß4 6.73 6.87 nsc0.34 nsc
0.23 0.19 nsc nsc
205442_at MFAP3L Microfibrillar-associated protein 3-like 0.34 0.26 0.29 nsc nsc
230214_at MRVI1 Murine retrovirus integration site-1 homolog
229839_at SCARA5 4.58
Hypothetical protein MGC45780 2.52 3.39 nsc0.34 nsc
0.19 0.21 nsc nsc
TSPAN12 Transmembrane 4 superfamily member 12
Non-metastatic cells 7, protein expressed in (nucleoside-
219274_at 0.33 0.3 0.3 nsc nsc
227556_at NME7 218326_s_at LGR4
4.54
Leucine-rich repeat-containing 3.22 nsc
G protein-coupled receptornsc
4 0.33 nsc
0.25 0.29 nsc nsc
diphosphate kinase) 213222_at PLCB1
205992_s_at IL15
Phospholipase C, ß1 (phosphoinositide-specific)
Interleukin 15
0.33
0.32
0.43
0.38
nsc
nsc
nsc
nsc
nsc
nsc
217875_s_at TMEPAI Transmembrane, prostate androgen-induced RNA
224516_s_at CXXC5 CXXC finger 5 4.39 2.33 nsc nsc0.31 0.47nscnsc nsc nsc
Methylenetetrahydrofolate dehydrogenase (NADP+
231592_at XIST X (inactive)-specific transcript 201761_at MTHFD2 4.08 3.85 cyclohydrolase
dependent) 2, methenyltetrahydrofolate nsc nsc0.3 0.31nsc0.48 nsc nsc

219534_x_at CDKN1C Cyclin-dependent kinase inhibitor 1C (p57, Kip2)

230560_at
201212_at
STXBP6
LGMN
Syntaxin-binding protein 6 (amisyn)
Legumain
4.08 2.15 nsc 2.040.30.3
0.36
0.41
nscnsc
0.3 nsc
0.48
nsc
nsc
201416_at SOX4 SRY (sex-determining region Y)-box 4 223168_at RHOU ras homolog gene3.95 family, member4.31 U 2.66 nsc0.28 0.45nscnsc nsc nsc
231897_at LTB4DH Leukotriene B4 12 hydroxydehydrogenase 0.28 0.4 0.48 nsc nsc
205187_at SMAD5 SMAD, mothers against DPP homolog 5 (Drosophila)
210427_x_at ANXA2 Annexin A2 3.92 3.63 2.82 nsc0.28 0.48nscnsc nsc nsc
208308_s_at GPI Glucose phosphate isomerase 0.27 0.41 nsc nsc nsc
213446_s_at IQGAP1 IQ motif containing GTPase activating protein 1
214687_x_at ALDOA 3.7
Aldolase A, fructose-bisphosphate 2.06 3.99 nsc0.27 0.34nsc0.45 nsc nsc
244774_at PHACTR2 Phosphatase and actin regulator 2 200736_s_at GPX1
3.69 1 2.34
Glutathione peroxidase nsc nsc0.27 0.49
nscnsc nsc nsc
200650_s_at LDHA Lactate dehydrogenase A 0.26 0.49 nsc nsc nsc
1560587_s_a
228588_s_at UBE2B Ubiquitin-conjugating enzyme E2B (RAD6 homolog)
t
PRDX5 Peroxiredoxin 5 3.61 4.57 2.27 2.01 0.23 0.43nscnsc nsc nsc
205081_at CRIP1 Cysteine-rich protein 1 (intestinal) 0.19 0.37 nsc nsc nsc
229733_s_at CBX6 Chromobox homolog 6 212038_s_at VDAC1 Voltage-dependent 3.46
anion channel3.43 1 nsc 2.360.17 0.33nscnsc 0.45 nsc
211745_x_at HBA1 Haemoglobin, 1 0.15 0.25 nsc nsc nsc
214414_x_at HBA2 Haemoglobin, 2 0.1 0.16 nsc nsc nsc
1565162_s_a
MGST1 Microsomal glutathione S-transferase 1 0.08 0.23 0.15 nsc nsc
Diagnosis

Laboratory diagnostic
methods

There has been a hope to find specific

markers in blood with which the diagnosis
endometriosis could be verified
One such marker is CA-125 that is produced
by cells from the celome epithelium. High
concentrations of CA-125 have been seen
together with ovarian cancer. Moderately
high concentrations are seen together with
inflammatory pelvic diseases and also
together with endometriosis. This lack of
specificity reduces the value of the
determination of CA-125.
THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
Role of Ca-125
Serum Ca-125 Level (U/ml

E: Endometriosis
A: Adenomyosis
L: Leiomyoma uteri

35.0 U/ml

14.8 U/ml

E E/A/L E/A/L
NORMAL E
PELVIC
WITHOUT WITH WITH A/L
E-OMA E-OMA WITHOUT
E-OMA E-OMA
THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
Role of Ca-125
Serum CA-125 level (U/ml)
Diagnosis n
Mean±SD Median (Range)

Normal pelvis 101 14.8±6.7 13.3 (4.7–35.2)

Endometriosis 249 72.8±110.9 43.0 (3.9–1200)
With endometrioma 88 50.8±68.6a 23.3 (8.0–472)
Without endometrioma 161 84.8±126.9a,b,d 55.0 (3.9–1200)
Endometriosis /Adenomyosis 184 70.8±79.4 46.0 (4.0–493)
/Leiomyoma
With endometrioma 62 60.5±88.6a,c 27.0 (4.0–493)
Without endometrioma 122 76.0±74.1a,b,d 48.8 (6.0–320)
Adenomyosis /Leiomyoma 241 40.8±58.2a 21.0 (5.0–456)
a: p<0.001 versus normal pelvis; b: p<0.001; E: endometrioma; A: adenomyosis;
c: p<0.005 versus E patients without endometriomas L: leiomyoma

Jo Kitawaki J, et al. Usefulness and limits of CA-125 in diagnosis

of endometriosis without associated ovarian endometrioma .
Hum Reprod 2005;20:1999-2003
Diagnosis
Body temperature: 37.6

The Benjamin sign 37.5

37.4

37.3
When at least three points of body

Suhu tubuh (derajat Celsius

temperature of vary between 36.8 to 37.2

)
37.5 detected during the menstrual 37.1
period, the patient should be strongly 37.0
suspected of having active 36.9
endometriosis. The Benjamin sign is a 36.8
useful screening tools for detecting the
36.7
endometriosis in adolescense girls.
36.6

36.5

36.4

36.3

36.2
Normal
36.1
Endometriosis
36.0
-7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7

Haid hari ke
Diagnosis

MRT, Magnetic
Resonance
Tomography

Magnetic Resonance Tomography

has hitherto been use very little but
there is a hope that the technique
might develop into a useful
diagnostic method.
Endometriomas – esp. with blood
under degradation – give rise to a
relatively characteristic picture,
provided they are more than 0,5
cm in diameter.
Human Reproduction 2007 22(4):945-952

Altered apoptosis and proliferation in endometrial stromal cells

of women with adenomyosis
Jehn-Hsiahn Yang et al
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College

METHODS: We enrolled 23 women with adenomyosis (study group) and 21 without (control group). Eutopic
endometrium was obtained and separated into single endometrial stromal cells (ES Cs). ESCs were treated in
vitro with hydrogen peroxide (H2O2) to examine their apoptosis using a fluorescence-activated cell s orter.
Cells were also treated with estradiol (E2), medroxyprogesteron e acetate, interleukin (IL)-6,
lipopolysaccharide and interferon -(IFN-) to test their proliferation using a non-radioactive cell proliferation
assay.

RESULTS: The percentage of annexin V ( + )/7-a mino-actinomycin D ( + ) ESCs was much lower in women
with adenomyosis after 24 h culture with and without H2O2 treatment when compared with the control group.
ESCs of adenomyosis proliferated more rapidly than those of the control group, whet her they were cultured
alone or were treated with E2, MPA, IL-6 or IFN-. The immunocytochemical Ki-67 labelling index was much
more prominent in adenomyotic ESCs than that of the control group (7.7% versus 1.1%, P < 0.001).
 THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
THE PRINCIPLES FOR IMAGING ANALYSIS
• Uterus enlargement
• Asymetrical of uterine shape to
mid-line echo
• Hetero-echogenicity of myometrial
imaging
 THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
THE PRINCIPLES FOR IMAGING ANALYSIS
• Uterus enlargement
• Asymetrical of uterine shape to mid-
line echo
• Hetero-echogenicity of myometrial
imaging
• Diffuse junctional-zone thickened
(not clearly discenible well defined
margins from the myometrium layer)
• Increase vascular density of tumour
in myometrium area (profused
vascularization may be suggestive of
malignancy)
 THE DIAGNOSTIC CRITERIA FOR ADENOMYOSIS
THE GOLDEN STANDARD FOR DIAGNOSTIC

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 PATHOLOGICAL FINDINGS OF
ADENOMYOSIS

• Usually hyperemic with thickened walls

• The foci are frequently scattered diffusely throughout the myometrium.
• Occasionally ， may be more circumscribed ， with the formation of a distinct
nodule ， an adenomyoma
• Basal endometrial hyperplasia invading a hyperplastic myometrial stroma
 THE GROWTH OF ADENOMYOSIS
BIOMOLECULAR GROWTH FACTORS
INTELEUKIN - 8 (IL-8) MONOCYTE CHEMOTACTIC PROTEIN - 1 (MCP-1)

Ulukus EC et al. Hum eprod 2005;20:2958-2963

 Immunohistologic Localization of Estrone Sulfatase in
Uterine Endometrium and Adenomyosis
Ezaki K, et al. Obstet Gynecol 2001;98:815-819

Location of Degree of staining*

estrone-sulfatase 0 1 2 3 Average (+) Staining
Adenomyosis 3 2 14 2 76% (16/21)
Basilar layer 5 11 11 1 43% (12/28)
Functional layer 20 8 0 0 0% ( 0/28)
* 0 and 1 are considered negative, and 2 and 3 are considered positive staining
 Treatment Choices for
Adenomyosis
CONSERVATIVE CONSERVATIVE RADICAL
MEDICINE SURGERY SURGERY
• Hormonal (GnRH- • Wedge • Histerectomy
agonists) Resection – Operative
• Enzymes Adenomyosis Laparoscopy
(Aromatase – Laparotomy – Laparotomy
inhibitots, anti – Operative
Estrogen sulfatase) Laparoscopy
– Interventional
imaging
 Histopathological Findings n %
Adenomyosis 103 30.7
Adenomyosis - Leiomyoma 68 20.2
Adenomyosis - Leiomyoma - Endometrioma 22 6.6
Adenomyosis - Leiomyoma - Endometrioma -
18 5.4
Endometriosis
Adenomyosis - Endometrioma 42 12.5
Adenomyosis - Endometrioma - Endometriosis 32 9.5
Adenomyosis - Endometriosis 37 11.0
Adenomyosis - Leiomyoma - Endometriosis 14 4.2
T o t a l 336 100.0
(2002-2006)
Medical Treatment

Infertility

Study Medical No treatment P-OR (95% CI)

Thomas, 1987 5/20 4/17 1.08 (0.24, 4.78)

Bayer, 1988 11/37 0.61 (0.24, 1.54) 17/36
Telimaa, 1988 6/18 6/14 0.67 (0.16, 2.79)
Telimaa, 1988 7/17 6/14 0.94 (0.23, 3.83)
Fedele, 1992 17/35 1.05 (0.42; 2.66) 17/36
Common Peto Odds Ratio 0.83 (0.50, 1.39)

0.1 0.2 1 5 10

Clearly, no increase in fertility of any medical treatment can be demonstrated with the
medication of neither danazol nor GnRH-agonists, showing nor has any medical treatment
proven its superiority effects.

Olive DL, Pritts EA. The Treatment of Endometriosis. Ann NY Acad Sci, 2002, 360-372
CONSERVATIVE SURGERY IN
REPRODUCTIVE AGE

RATIO BETWEEN
< 1/3 TUMOR VOLUME TO UTERINE VOLUME ≥ 1/3

> 50% REST OF ENDOMETRIAL CAVITY ≤ 50%

NUMBER OF SURGICAL PROCEDURE(S)
0 FOR RESECTION OF ADENOMYOSIS ≥1

ADENOMYOSIS 12.4% SUB-TOTAL / TOTAL

(22/177)
WEDGE-RESECTION HYSTERECTOMY
+ GnRH-a till Ca-125<14U/ml

14.2 ± 8.3 months

26.4%
(41/155) PREGNANCY RATE
9.0% RECCURENCY RATE 12.5%
(14/155) 23.2 ± 7.5 months (2/16)
ARTERIOGRAPHY : UTERINE ARTERY EMBOLIZATION
Diagnostic & Treatment
 Changes in Quality of Life After
Uterine Artery Embolization
Variables Before * After * p
Ability to perform activities of daily life 7 2 <0.001
Ability to socialize outside the home 7 1 <0.001
Overall energy level 8 1 <0.001
Interest in sexual intercourse 7.5 3 0.096
Pain during sexual intercourse 5.5 1 0.017
Pain or cramping during menstruation 8 2 <0.001
Note.—1 = no severity or impairment, 10 = severe severity or impairment.
* Median response N : 13

Gary P. Siskin GP et al. Uterine Artery Embolization for the Treatment of Adenomyosis : Clinical
Response and Evaluation with MR Imaging. AJR 2001; 177:297-302
 MAGNETIC RESONANCE IMAGING
Diagnostic & Treatment
MRI-Guided Technique Speeds Fibroid Treatment. Fibroids can be safely treated in 60% less time using manual interleaved MR-
guided focused ultrasound (MRgFUS), according to researchers from the Lahey Clinic (Burlington, Mass). Follow-up visits found
the new MRI-guided technique produced no serious adverse side effects, and 12 of the 14 patients had marked improvements in
their symptoms. Lead author: George A. Holland, MD

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THE USE OF 3RD GENERATION OF MRI

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Clinical Manifestation

Recurrence

During periods of medical treatment the endometriotic lesions become inactive and the
symptoms disappear. After a time interval which can vary widely, the endometriosis might
become activated by the endogenous hormonal influence with recurrent symptomatology.
Endometriosis also shows recurrence after surgical intervention. Regardless of the mode of
treatment, the frequency of recurrence is about 15% within 3 years and 50% within 5
years.
 ADENOMYOSIS
CLINICAL MANAGEMENT
DIAGNOSTIC PROCEDURES (Laboratory, Biopsy, Imaging)

CONCERN FOR THE NOT-CONCERN FOR

FUTURE REPRODUCTIVE REPRODUCTIVE
FUNCTION FUNCTION

CONSERVATIVE MEDICAL TREATMENT RADICAL

MANAGEMENT & MANAGEMENT &
INTERVENTION (HORMONES, ANTI-ENZYMES) INTERVENTION

INTERVENTIONAL NON-SURGERY
UTERINE ARTERY EMBOLIZATION
(MRI MICROVIBRATION)

LAPAROTOMY LAPAROTOMY / LAPAROSCOPY

UTERINE WEDGE RESECTION & TOTAL HYSTERECTOMY
METROPLASTIC SURGERY (VAGINAL/ ABDOMINAL/ LAPAROSCOPICALLY)
FOR KIND ATTETION