Adenomyosis and endometrial ablation

Objective To present a synopsis concerning adenomyosis uteri interna with respect to endometrial ablation. The definition of adenomyosis, different diagnostic methods and their effectiveness, as well as the influence of adenomyosis on the outcome after endometrial ablation, are discussed. Design Review. Setting Obstetrics and gynaecology clinic of an academic teaching university hospital. Results Depending on which definition is used, the incidence of adenomyosis varies between 8 and 61%. The term 'adenomyosis' should be restricted to those cases with a deeper ingrowth of glands, as only these show clinical symptoms. Adenomyosis can not be diagnosed or excluded with certainty by either sonography, diagnostic hysteroscopy, or dilation and curettage. Needle biopsies of the myometrium show low accuracy and are difficult to obtain. Hysteroscopic resection of myometrium detects some cases of adenomyosis, but misses the majority. In patients undergoing hysterectomy after unsuccessful endometrial ablation, incidence rates of 75-100% for adenomyosis were reported. Thus adenomyosis might be a principal reason for treatment failure. As there is no safe means of excluding adenomyotic foci, adenomyosis can be assumed in patients with an enlarged uterus and marked dysmenorrhoea. Conclusion Patients with dysmenorrhoea and uteri > 10 cm show a high incidence of adenomyosis. Because of an increased risk of failure, these patients should be excluded from endometrial ablation.