Uterine-sparing techniques are promising for managing adenomyosis with less risk of reintervention

Adenomyosis is a common benign gynecologic condition with a prevalence range of 20% to 34%. The incidence rises with age and peaks in ages 40–49 years. The condition is associated with painful menses, heavy menstrual bleeding, chronic pelvic pain, infertility, dyspareunia, and obstetric complications. The treatment usually includes medical therapy but has side effects and is also related to recurrence.

Adenomyomectomy, uterine artery embolization (UAE), and image-guided thermal ablation, including [high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and microwave ablation (MWA)]are the uterine-sparing interventions and are less common. These procedures improve adenomyosis symptoms and eliminate the hysterectomy need. However, more data should be available regarding the risks of recurrence and reintervention after these treatments.

Researchers said that considering the background of adenomyosis, more prone to relapse after treatment and in an attempt to provide valuable advice for clinical decision-making, we performed a systematic review and meta-analysis to evaluate recurrence and reintervention following uterine-sparing interventions.

The database searched were Web of Science, MEDLINE, Cochrane Library, EMBASE, ClinicalTrials.gov, and Google Scholar using relevant terms like “adenomyosis,” “recurrence,” “reintervention,” “relapse,” and “recur.”

The study results are:

• Forty-two studies represented 5,877 patients.
• Following adenomyomectomy, UAE, and image-guided thermal ablation, the recurrence rate was 12.6%, 29.5% and 10.0%, respectively.
• The reintervention rates were 2.6%, 12.8% and 8.2%, respectively.

They explained that in our review, we reported low rates of recurrence and reintervention rates for all uterine-sparing techniques.

Subgroup analyses revealed further improvement in recurrence and reintervention rates with adjuvant hormone therapy.

This indicates that medical adjuvant treatment may aid in providing longer, more durable symptom control than surgery alone.

Further investigations are warranted with a larger sample size.

Further reading:

Liu, Lu MD; Tian, Hongyan MM; Lin, Dongmei MM; Zhao, Liang MM; Wang, Hui MM; Hao, Yi MM. Risk of Recurrence and Reintervention After Uterine-Sparing Interventions for Symptomatic Adenomyosis: A Systematic Review and Meta-Analysis. Obstetrics & Gynecology 141(4):p 711-723, April 2023. | DOI: 10.1097/AOG.0000000000005080