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Focal Adenomyosis — Surgical Treatment

Adenomyomectomy and Uterus-Preserving Surgery for Localized Adenomyosis

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Focal Adenomyosis — Surgical Treatment?

Focal adenomyosis (also called adenomyoma) is a circumscribed nodular form of adenomyosis with localized ectopic endometrial glands and stroma within the myometrium.

Distinguished from diffuse adenomyosis (entire myometrium thickened) and uterine fibroids (smooth muscle tumors without endometrial elements).

Pathophysiology: invagination of basal endometrium into myometrium, possibly via injury, hormonal stimulation, or genetic predisposition.

MRI features: heterogeneous low-signal mass with high-signal cystic spots and indistinct borders (vs. fibroid: well-circumscribed, dark T2 signal, capsular pseudocapsule).

Surgical removal challenging due to lack of distinct cleavage plane (unlike fibroids which shell out cleanly).

Adenomyomectomy preserves the uterus, important for fertility-desiring patients.

Symptoms

Severe dysmenorrhea (worsening with age, often unresponsive to NSAIDs).
Abnormal uterine bleeding (heavy menstrual bleeding, intermenstrual spotting).
Chronic pelvic pain.
Dyspareunia.
Infertility or recurrent pregnancy loss.
Pelvic pressure or bulk symptoms (large adenomyomas).
Anemia from chronic heavy bleeding.

Risk Factors

Reproductive age (30-50 years most common).
Multiparity (especially with cesarean section history).
Prior uterine surgery (myomectomy, dilation and curettage).
Tamoxifen use.
Endometriosis (frequently coexists with adenomyosis).
Estrogen-dominant states.
Genetic predisposition (familial cases reported).

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe dysmenorrhea unresponsive to NSAIDs.
  • Heavy menstrual bleeding with iron deficiency anemia.
  • Chronic pelvic pain affecting quality of life.
  • Infertility evaluation revealing focal adenomyosis on imaging.
  • Suspected uterine mass on examination or imaging.
  • Failed medical therapy (combined oral contraceptives, levonorgestrel IUD, GnRH agonists).

Treatment Methods

01
Pre-operative imaging: 3D transvaginal ultrasound, MRI pelvis (gold standard, T2-weighted sequences), evaluation of fibroid vs adenomyoma differential.
02
Medical therapy first-line: NSAIDs, combined oral contraceptives, levonorgestrel-releasing IUD, GnRH agonists ± add-back therapy, dienogest.
03
Surgical options for failure of medical therapy or fertility-related concerns:
04
Adenomyomectomy (open, laparoscopic, or robotic): excision of focal lesion with multilayer myometrial closure.
05
Hysteroscopic resection for submucosal adenomyomas (limited indication, depth-restricted).
06
Wedge resection of fundus or atypical incisions for diffuse focal disease.
07
Hysterectomy: definitive treatment for women with completed family or severe disease.
08
High-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE): emerging non-surgical options with mixed results.
09
Postoperative care: pain control, return to activity, contraception advice (avoid pregnancy 6-12 months post-adenomyomectomy due to uterine rupture risk).
10
Pregnancy management after adenomyomectomy: serial ultrasound, monitor for uterine rupture, consider planned cesarean delivery before labor.
11
Outcomes: symptom resolution 70-90%; fertility outcomes variable depending on disease extent and surgical complexity.
12
Recurrence risk 10-30% over 5 years (residual disease or progression).
13
Long-term follow-up: annual pelvic examination, ultrasound for recurrence monitoring.

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.