Department of Obstetrics and Gynecology, Pavlodar Branch of the Semey Medical University, 72/1 Toraigyrov Str., 140002, Pavlodar, Republic of Kazakhstan.
Arch Gynecol Obstet. 2023 Jul;308(1):171-181. doi: 10.1007/s00404-023-06982-1. Epub 2023 Apr 15.
Adenomyosis is identified by the enlargement of the uterus secondary to such areas of the endometrium as the endometrial glands and stroma located deep in the myometrium, which causes its hyperplasia and hypertrophy. The most common signs of the development of adenomyosis in a patient are copious menstrual bleeding and dysmenorrhea. However, it should be borne in mind that in some patients, the disease may be asymptomatic. Despite the wide abundance of imaging and other diagnostic methods for diagnosing adenomyosis, there are currently no standard verified diagnostic criteria for pathologists. In addition, women with adenomyosis often have other concomitant gynaecological diseases, such as endometriosis or leiomyomas, which makes it difficult to diagnose and choose the optimal treatment for patients. Therefore, the purpose of this study was to highlight up-to-date and relevant information for the practitioner about the epidemiology, clinical manifestations, diagnostics and treatment options for adenomyosis. Sources from four databases (PubMed, Web of Science, Elsevier and Google Scholar) were used to search for data. As a result of a literature review, it was established that the "gold" standard for the diagnostics of adenomyosis is histological research methods, in particular, biopsy performed during hysteroscopy or laparoscopy, whereas imaging methods (transvaginal sonography, magnetic resonance imaging) are more often used for differential diagnostics of adenomyosis with other diseases. In addition, magnetic resonance imaging allows for a better differential diagnostics between adenomyosis and myomatosis and helps to recognise the disease at an early stage. Regarding treatment, there is currently no particular therapy and algorithms for the treatment of adenomyosis, which is primarily due to the lack of precise criteria for the diagnostics of the disease. However, the most effective therapeutic methods at the present stage are the use of aromatase inhibitors and gonadotropin-releasing hormone antagonists, whilst minimally invasive techniques, in particular, endometrial ablation and uterine artery embolisation, are becoming increasingly popular amongst surgical techniques.
子宫腺肌病是由子宫内膜腺体和间质位于子宫肌层深部等部位的子宫增大引起的，导致其增生和肥大。腺肌病患者最常见的发展迹象是大量月经出血和痛经。然而，应该记住，在一些患者中，该疾病可能无症状。尽管有广泛的影像学和其他诊断方法可用于诊断腺肌病，但目前病理学家没有标准的验证诊断标准。此外，患有腺肌病的妇女常有其他伴随的妇科疾病，如子宫内膜异位症或子宫肌瘤，这使得诊断和为患者选择最佳治疗方法变得困难。因此，本研究的目的是为临床医生提供关于腺肌病的流行病学、临床表现、诊断和治疗选择的最新和相关信息。从四个数据库（PubMed、Web of Science、Elsevier 和 Google Scholar）中搜索数据来源。通过文献回顾，确定腺肌病诊断的“金标准”是组织学研究方法，特别是在宫腔镜或腹腔镜检查期间进行的活检，而影像学方法（经阴道超声、磁共振成像）更常用于腺肌病与其他疾病的鉴别诊断。此外，磁共振成像可更好地区分腺肌病和肌瘤，并有助于早期发现该疾病。关于治疗，目前尚无特定的腺肌病治疗方法和方案，这主要是由于缺乏精确的疾病诊断标准。然而，在现阶段最有效的治疗方法是使用芳香化酶抑制剂和促性腺激素释放激素拮抗剂，而微创技术，特别是子宫内膜消融和子宫动脉栓塞术，在手术技术中越来越受欢迎。
