Prognosis

The management of uterine adenomyosis poses challenges, and the prognosis is influenced by:

  • the range and severity of presenting symptoms, which may vary depending on the depth of lesions[180]

  • the chosen medical or surgical management, which in turn varies based on the patient's fertility intentions, age, and the presence of co-existing pathologies.[16][86]

After menopause, oestrogen deficiency may decrease both symptoms and prevalence of adenomyosis.[12]

Recurrence

Recurrence following cessation of medical therapies is almost universal.[181][182]

The definitive treatment for adenomyosis is a hysterectomy. However, patients opting for certain uterus-sparing surgeries may benefit from preserving their fertility potential, albeit with the risk of recurrence and the possibility of needing further interventions.

One meta-analysis of 42 studies reported an overall symptom recurrence rate of 15.2% after uterine-sparing treatments such as adenomyomectomy, uterine artery embolisation (UAE), and image-guided thermal ablation techniques, with a follow-up period ranging from 6 to 95 months (most studies ≥24 months).[183] The reported recurrence rate was 12.6% for adenomyomectomy, 29.5% for UAE, and 10.0% for image-guided thermal ablation (specifically reported after using high-intensity focused ultrasound).[183]

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