Abstract：
To describe the current evidence-based diagnosis and management of adenomyosis.
All patients with a uterus of reproductive age.
Diagnostic options include transvaginal sonography and magnetic resonance imaging. Treatment options should be tailored to symptoms (heavy menstrual bleeding, pain, and/or infertility) and include medical options (non-steroidal anti-inflammatory drugs, tranexamic acid, combined oral contraceptives, levonorgestrel intrauterine system, dienogest, other progestins, gonadotropin-releasing analogues), interventional options (uterine artery embolization), and surgical options (endometrial ablation, excision of adenomyosis, hysterectomy).
Outcomes of interest include reduction in heavy menstrual bleeding, reduction in pelvic pain (dysmenorrhea, dyspareunia, chronic pelvic pain), and improvement in reproductive outcomes (fertility, miscarriage, adverse pregnancy outcomes).
This guideline will benefit patients with gynaecological complaints that may be caused by adenomyosis, especially those patients who wish to preserve their fertility, by presenting diagnostic methods and management options. It will also benefit practitioners by improving their knowledge of various options.
Databases searched were MEDLINE Reviews, MEDLINE ALL, Cochrane, PubMed, EMBASE. The initial search was completed in 2021 and updated with relevant articles in 2022. Search terms included adenomyosis, adenomyoses, endometritis (used/indexed as adenomyosis before 2012), (endometrium AND myometrium) uterine adenomyosis/es, symptom/s/matic adenomyosis] AND [diagnosis, symptoms, treatment, guideline, outcome, management, imaging, sonography, pathogenesis, fertility, infertility, therapy, histology, ultrasound, review, meta-analysis, evaluation]. Articles included randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Articles in all languages were searched and reviewed.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Table A1 for definitions and Table A2 for interpretations of strong and conditional [weak] recommendations).
Obstetrician-gynaecologists, radiologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, residents, and fellows.
Adenomyosis is common in reproductive-aged women. There are diagnostic and management options that preserve fertility available.
RECOMMENDATIONS.
All patients with a uterus of reproductive age.
Diagnostic options include transvaginal sonography and magnetic resonance imaging. Treatment options should be tailored to symptoms (heavy menstrual bleeding, pain, and/or infertility) and include medical options (non-steroidal anti-inflammatory drugs, tranexamic acid, combined oral contraceptives, levonorgestrel intrauterine system, dienogest, other progestins, gonadotropin-releasing analogues), interventional options (uterine artery embolization), and surgical options (endometrial ablation, excision of adenomyosis, hysterectomy).
Outcomes of interest include reduction in heavy menstrual bleeding, reduction in pelvic pain (dysmenorrhea, dyspareunia, chronic pelvic pain), and improvement in reproductive outcomes (fertility, miscarriage, adverse pregnancy outcomes).
This guideline will benefit patients with gynaecological complaints that may be caused by adenomyosis, especially those patients who wish to preserve their fertility, by presenting diagnostic methods and management options. It will also benefit practitioners by improving their knowledge of various options.
Databases searched were MEDLINE Reviews, MEDLINE ALL, Cochrane, PubMed, EMBASE. The initial search was completed in 2021 and updated with relevant articles in 2022. Search terms included adenomyosis, adenomyoses, endometritis (used/indexed as adenomyosis before 2012), (endometrium AND myometrium) uterine adenomyosis/es, symptom/s/matic adenomyosis] AND [diagnosis, symptoms, treatment, guideline, outcome, management, imaging, sonography, pathogenesis, fertility, infertility, therapy, histology, ultrasound, review, meta-analysis, evaluation]. Articles included randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Articles in all languages were searched and reviewed.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Table A1 for definitions and Table A2 for interpretations of strong and conditional [weak] recommendations).
Obstetrician-gynaecologists, radiologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, residents, and fellows.
Adenomyosis is common in reproductive-aged women. There are diagnostic and management options that preserve fertility available.
RECOMMENDATIONS.
摘要：
目的：描述当前子宫腺肌病的循证诊断和治疗方法。
方法：所有育龄子宫患者。
方法：诊断选择包括经阴道超声和磁共振成像。治疗方案应根据症状（大量月经出血，疼痛,和/或不孕症），并包括医疗选择（非甾体类抗炎药，氨甲环酸,联合口服避孕药，左炔诺孕酮宫内节育系统，Dienogest,其他孕激素,促性腺激素释放类似物），介入选择（子宫动脉栓塞），和手术选择(子宫内膜消融，子宫腺肌病切除术,子宫切除术）。
结果：关注的结果包括减少大量月经出血，减少盆腔疼痛（痛经，性交困难,慢性盆腔疼痛)，和生殖结果的改善(生育率，流产,不良妊娠结局)。
结果：该指南将使可能由子宫腺肌病引起的妇科疾病患者受益，尤其是那些希望保持生育能力的患者，通过提供诊断方法和管理选项。它还将通过提高他们对各种选择的了解而使从业者受益。
方法：搜索的数据库是MEDLINE评论，MEDLINE所有，科克伦,PubMed,Embase.初步搜索于2021年完成，并于2022年更新了相关文章。搜索词包括子宫腺肌病，腺肌病,子宫内膜炎（2012年之前用作/索引为子宫腺肌病），（子宫内膜和子宫肌层）子宫腺肌病，症状/s/多发性子宫腺肌病]和[诊断，症状,治疗,指导方针，结果,管理,成像,超声检查,发病机制，生育力,不孕症,治疗,组织学,超声，review,荟萃分析，评估]。文章包括随机对照试验，荟萃分析，系统评价,观察性研究，和病例报告。检索并审查了所有语言的文章。
方法：作者使用建议分级评估对证据质量和建议强度进行了评估，开发和评估(等级)方法。见在线附录A（表A1的定义和表A2的强和有条件的[弱]建议的解释）。
■妇产科医生，放射科医生,家庭医生,急诊医生,助产士,注册护士,执业护士,医学生,居民,和研究员。
结论：子宫腺肌病常见于育龄妇女。有一些诊断和管理选项可以保持生育能力。
结论：建议。
方法：所有育龄子宫患者。
方法：诊断选择包括经阴道超声和磁共振成像。治疗方案应根据症状（大量月经出血，疼痛,和/或不孕症），并包括医疗选择（非甾体类抗炎药，氨甲环酸,联合口服避孕药，左炔诺孕酮宫内节育系统，Dienogest,其他孕激素,促性腺激素释放类似物），介入选择（子宫动脉栓塞），和手术选择(子宫内膜消融，子宫腺肌病切除术,子宫切除术）。
结果：关注的结果包括减少大量月经出血，减少盆腔疼痛（痛经，性交困难,慢性盆腔疼痛)，和生殖结果的改善(生育率，流产,不良妊娠结局)。
结果：该指南将使可能由子宫腺肌病引起的妇科疾病患者受益，尤其是那些希望保持生育能力的患者，通过提供诊断方法和管理选项。它还将通过提高他们对各种选择的了解而使从业者受益。
方法：搜索的数据库是MEDLINE评论，MEDLINE所有，科克伦,PubMed,Embase.初步搜索于2021年完成，并于2022年更新了相关文章。搜索词包括子宫腺肌病，腺肌病,子宫内膜炎（2012年之前用作/索引为子宫腺肌病），（子宫内膜和子宫肌层）子宫腺肌病，症状/s/多发性子宫腺肌病]和[诊断，症状,治疗,指导方针，结果,管理,成像,超声检查,发病机制，生育力,不孕症,治疗,组织学,超声，review,荟萃分析，评估]。文章包括随机对照试验，荟萃分析，系统评价,观察性研究，和病例报告。检索并审查了所有语言的文章。
方法：作者使用建议分级评估对证据质量和建议强度进行了评估，开发和评估(等级)方法。见在线附录A（表A1的定义和表A2的强和有条件的[弱]建议的解释）。
■妇产科医生，放射科医生,家庭医生,急诊医生,助产士,注册护士,执业护士,医学生,居民,和研究员。
结论：子宫腺肌病常见于育龄妇女。有一些诊断和管理选项可以保持生育能力。
结论：建议。
