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Adenomyosis and treatment

B Borghese, P Santulli, L Marcellin, C Chapron
Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix)...
March 11, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
C Huchon, G Aubry, S Ploteau, A Fauconnier
In case of consultation for chronic pelvic pain or suspicion of endometriosis, it is recommended to evaluate the pain (intensity, resonance) and to search out the evocative and localizing symptoms of endometriosis (Grade B). The main symptoms suggestive of endometriosis are: severe dysmenorrhea (NP2), deep dyspareunia (NP2), painful defecation during menstruation (NP2), urinary tract symptoms during menstruation (NP2) and infertility (NP2). In patients with chronic pelvic pain, it is recommended to search deep infiltrating endometriosis in patients with painful defecation during menstruation or severe deep dyspareunia (Grade B)...
March 9, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
John Jarrell
Historically, the evolutionary origins of menstruation have been based on two theories: the ability to eliminate infectious agents carried to the uterus with spermatozoa and the comparative conservation of energy with menstruation compared to its absence. In the menstruating species, more recent theories have identified spontaneous decidualization as the key adaptive mechanism. Spontaneous decidualization is seen as a mechanism to provide the mother with protection from the invasive characteristics of the embryo...
February 8, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Jacques Donnez, Olivier Donnez, Marie-Madeleine Dolmans
Like endometriosis, uterine adenomyosis is another enigmatic disease and remains a source of controversy. Uterine adenomyosis is characterized by the presence of endometrial glands in the myometrium. Two main theories may explain its pathogenesis: adenomyosis may arise from invagination of the myometrial basalis into the myometrium; or an alternative theory maintains that it may result from metaplasia of displaced embryonic pluripotent müllerian remants or differentiation of adult stem cells. Uterine adenomyosis is responsible for pelvic pain, abnormal bleeding, and infertility...
March 8, 2018: Fertility and Sterility
Andrew J Gall, June E Olds, Arno Wünschmann, Laura E Selmic, James Rasmussen, Anne D Lewis
Reproductive lesions have been described in various nonhuman primate species, including rhesus macaques ( Macaca mulatta), cynomolgus macaques ( Macaca fascicularis), baboons ( Papio spp.), squirrel monkeys ( Saimiri sciureus), and chimpanzees ( Pan spp.); however, there are few publications describing reproductive disease and pathology in Japanese macaques ( Macaca fuscata). A retrospective evaluation of postmortem reports for two captive M. fuscata populations housed within zoos from 1982 through 2015 was completed, comparing reproductive diseases diagnosed by gross pathology and histopathology...
March 2018: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
Tamara N Kruse, Michelle R Bowman, Jan C Ramer, Melissa A Fayette, Leah L Greer, Cynthia K Stadler, Michael M Garner, Jeffry S Proudfoot
Uterine lesions in two orangutans were effectively managed with surgical intervention. A 26-year-old hybrid orangutan ( Pongo spp.) was diagnosed with uterine adenomyosis based on advanced imaging. Histologic evaluation identified multifocal myometrial endometriosis, a variant of adenomyosis. A 27-year-old Bornean orangutan ( Pongo pygmaeus) was diagnosed with a focal uterine fibroid based on histologic examination. The animals were housed at separate institutions and initially presented with dysmenorrhea and menorrhagia...
March 2018: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
Annefleur Machteld de Bruijn, Paul Nm Lohle, Judith Af Huirne, Jolanda de Vries, Moniek Twisk, Wouter Jk Hehenkamp
BACKGROUND: Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce symptoms and improve quality of life. However, randomized controlled trials are lacking. OBJECTIVE: With this study, we aim to evaluate the impact of UAE on Health-Related Quality of Life (HRQOL) in a randomized comparison to hysterectomy in patients with symptomatic adenomyosis...
March 1, 2018: JMIR Research Protocols
Ching-Jung Lin, Teh-Fu Hsu, Yen-Hou Chang, Ben-Shian Huang, Ling-Yu Jiang, Peng-Hui Wang, Yi-Jen Chen
OBJECTIVE: To evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing the recurrence of postoperative adenomyosis-related symptoms. MATERIALS AND METHODS: From January 2005 through December 2014, a retrospective study including 133 patients with symptomatic adenomyosis undergoing conservative uterine-sparing surgery followed by gonadotropin-releasing hormone agonist treatment was conducted. We excluded the 18 patients who did not meet the inclusion criteria...
February 2018: Taiwanese Journal of Obstetrics & Gynecology
Xiao-Ying Zhang, Ying-Shu Guo, Jiu-Mei Chen, Jin-Juan Wang, Hong Ye, Chun-Yi Zang, Hua Duan
OBJECTIVES: To evaluate the efficacy and safety of GnRH-α pretreatment with HIFU ablation for diffuse adenomyosis. METHODS: From January 2014 to December 2016, 61 patients were divided into two groups. Twenty-three patients with larger uteri received pretreatment with GnRH-αand were then subjected to HIFU, and 38 patients underwent HIFU alone. The technical parameters included treatment time, sonication time, average sonication power, treatment intensity, total energy, non-perfusion volume (NPV) and NPV ratio...
February 15, 2018: International Journal of Hyperthermia
V Tskhay, A E Schindler, G Мikailly
Endometriosis is among the prevalent gynecological diseases and diagnosed in 10% of women of reproductive age. Endometriosis/adenomyosis is becoming increasingly a health-social problem, which is associated with severe clinical manifestations and recurrent disease which has a negative effect on quality of life, women ability to work and her reproductive function. This article presents modern approaches of drug therapy to treat severe forms of adenomyosis. We have reviewed recent major studies in the field of surgical treatment of this disease, analyzed the main stages of disease progress and the results of our surgeries...
February 15, 2018: Gynecological Endocrinology
Yanmei Hou, Zhenli Qin, Kefeng Fan, Yanhua Xu, Xiaoge Huang
Adenomyosis is a pathological gynaecological condition characterized by benign invasion of the endometrium into the myometrium. High intensity focused ultrasound (HIFU) is one of the most common therapeutic strategies for the treatment of adenomyosis. However, the efficacy of single HIFU therapy is insufficient for the treatment of patients with adenomyosis. In the present study, the efficacy of HIFU and metformin for the treatment of adenomyosis was analyzed in 274 patients with adenomyosis who were admitted to Jinan Maternity and Child Care Hospital...
February 2018: Experimental and Therapeutic Medicine
Tasuku Harada, Ikuko Ohta, Yusuke Endo, Hiroshi Sunada, Hisashi Noma, Fuminori Taniguchi
Background: SR-16234 is a selective estrogen receptor modulator (SERM) structurally different from approved SERM and has been reported to have estrogen receptor (ER) α antagonistic activity and strong affinity with a weak partial agonistic activity to ERβ receptor. SR-16234 showed strong inhibitory effects on transplanted endometrial cysts in the endometriosis model of rat and mouse. In this clinical trial, efficacy and safety of SR-16234 have been evaluated in endometriosis patients...
December 2017: Yonago Acta Medica
Tainá Pezzin Rocha, Marina Paula Andres, Giuliano Moysés Borrelli, Mauricio Simões Abrão
Adenomyosis is a benign gynecological disease observed in women in their reproductive age. Recent studies have shown that adenomyosis might be a relevant factor for infertility, either impairing implantation or leading to early miscarriage. However, conservative treatment of infertility related to adenomyosis is still unclear. This study systematically reviews the literature for the reproductive outcomes of the available conservative treatments for patients with adenomyosis-associated infertility. We conducted a search in PubMed/Medline for studies in English published in the last 7 years and included 16 studies...
January 1, 2018: Reproductive Sciences
W Glenn McCluggage
Accurate staging of cancers is an important determinant of prognosis and guides optimal patient treatment. Although the International Collaboration on Cancer Reporting recommends that endometrial cancers (including carcinosarcomas) are pathologically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 system, in many areas TNM [American Joint Committee on Cancer (AJCC) or Union for International Cancer Control (UICC)] staging is used or even mandated; these latter systems are based on FIGO 2009...
March 2018: Advances in Anatomic Pathology
Xuesi Hou, Qingchen Zhou, Lei Wang, Lu Cheng, Jiping Zhao
To discuss the acupuncture and moxibustion thoughts of diagnosis and treatment for secondary dysmenorrhea of adenomyosis on the basis of disease location and pathogenesis. In clinic, we take the "principle, method, prescription, acupoint and technic" as the outline, paying attention to identify disease location and establishing the method of "promoting blood to remove stasis, regulating thoroughfare vessel and conception vessel" on the basis of the pathogenesis of "stasis obstructing uterus, disharmony of thoroughfare vessel and conception vessel"...
October 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
Caterina Exacoustos, Giovanna De Felice, Alessandra Pizzo, Giulia Morosetti, Lucia Lazzeri, Gabriele Centini, Emilio Piccione, Errico Zupi
STUDY OBJECTIVE: To assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extraovarian lesions including adhesions, deep infiltrating endometriosis (DIE), and adenomyosis. DESIGN: Retrospective observational study (Canadian Task Force classification II-2). SETTING: Two university hospitals. PATIENTS: Two hundred fifty-five symptomatic women with at least 1 ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation...
January 17, 2018: Journal of Minimally Invasive Gynecology
Eisen Liang, Bevan Brown, Maxim Rachinsky
BACKGROUND: Uterine artery embolisation (UAE) is a possible uterine-sparing treatment option for women with unsuccessful conservative management for adenomyosis-related heavy menstrual bleeding (HMB) and dysmenorrhoea. AIM: To conduct a clinical audit on the efficacy and safety of UAE for symptomatic adenomyosis. MATERIALS AND METHODS: Retrospective review of 309 women who underwent UAE identified 117 women with magnetic resonance imaging features of adenomyosis (junctional zone thickness ≥ 12 mm)...
January 18, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
Kohei Nakamura, Kentaro Nakayama, Kaori Sanuki, Toshiko Minamoto, Tomoka Ishibashi, Emi Sato, Hitomi Yamashita, Masako Ishikawa, Satoru Kyo
This study aimed to describe the long-term outcomes of patients with menorrhagia treated with microwave endometrial ablation (frequency, 2.45 GHz), as well as to identify factors associated with recurrence or re-surgery. This retrospective cohort study was conducted from 2007 to 2015 at Shimane University Hospital in Japan. Patients with severe menorrhagia and a desire to preserve their uterus were included in the study. Clinical factors associated with recurrence of menorrhagia or re-surgery were analyzed with a multivariable logistic regression model...
December 2017: Oncology Letters
Xishi Liu, Ding Ding, Yunyun Ren, Sun-Wei Guo
To test the hypothesis that the lesional stiffness as measured by transvaginal elastosonography (TVESG) correlates with the extent of fibrosis in adenomyotic (AM) lesions, and thus TVESG can be used to diagnose AM, we conducted 2 studies. The first evaluated the relationship, if any, between lesional stiffness and lesional histology in 35 women with histologically confirmed AM in comparison with tissue stiffness in 11 control myometrial (CM) and 8 uterine fibroids (UFs) tissue samples. The second validated the relationship between lesional stiffness and the severity of dysmenorrhea and the amount of menses in AM patients by recruiting 112 patients diagnosed with AM, 67 with UF, and 130 controls...
January 1, 2018: Reproductive Sciences
Lixia Yu, Linying Xu, Xiaoyan Xu
RATIONALE: Cornual ectopic pregnancy in adenomyosis patients is a rare clinical condition, which may require careful approach for accurate diagnosis and treatment. PATIENT CONCERNS: A 38-year-old woman presented with amenorrhea for 8 weeks and serum HCG levels of 1455 mmol/L. The B ultrasound showed an endometrial thickness of 1.7 cm, and the presence of a cystic structure (16 6 mm) at the right uterine horn. Color Doppler flow imaging (CDFI) accurately detected and confirmed the position of the cystic structure with its clear boundaries...
December 2017: Medicine (Baltimore)
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