[New concepts on pathophysiology, diagnosis and treatment of adenomyosis].

Adenomyosis is a relatively frequent disease, difficult to diagnose and which pathophysiology remains unknown. The treatment for the women which want to conserve or improve their fertility remains not well defined. Endovaginal ultrasonography seems to be as effective as MRI for the diagnosis of adenomyosis. Gn-RH agonist decreases symptoms and uterine volume; however, the symptoms reappear after discontinuation of agonist therapy, and side effects limit their prolonged use. Progestérone receptor modulators, anti-progestative and danazol or levonorgestrel-releasing intra-uterine system have been used as therapeutic modalities for adenomyosis, but the lack of controlled studies make their efficacy difficult to quantify. Some women with superficial adenomyosis may theoretically benefit from hysteroscopic myometrial or endometrial resection, but these procedures would be limited to women not wishing to conceive. Laparoscopic myometrial electrocoagulation or excision has proven to be effective but pregnancy following these techniques poses special problems, particularly the increased risk of uterine rupture. Transvaginal ultrasonography can successfully diagnose adenomyosis. Medical and conservative surgical treatments are already available.