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Review
. 2023 Jun 27;13(13):2182.
doi: 10.3390/diagnostics13132182.

Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature

Fani Gkrozou  1 , Anastasia Vatopoulou  1 , Chara Skentou  1 , Minas Paschopoulos  1
Affiliations
Review

Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature

Fani Gkrozou et al. Diagnostics (Basel). .

Abstract

Introduction: Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies.

Material and methods: The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy.

Results: The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection.

Conclusions: Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies.

Keywords: adenomyosis; diagnosis; hysteroscopy; management; treatment; vaginoscopic approach.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Irregular endometrium with openings.
Figure 2
Figure 2
Hypervascularisation.
Figure 3
Figure 3
An endometrial “strawberry” pattern.
Figure 4
Figure 4
Fibrous cystic appearance of intrauterine lesions.
Figure 5
Figure 5
Haemorrhagic cystic lesions presenting with a dark blue or chocolate brown appearance.
See this image and copyright information in PMC

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