Abstract：
OBJECTIVE: Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes.
RESULTS: Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy.
CONCLUSIONS: This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.
RESULTS: Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy.
CONCLUSIONS: This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.
摘要：
目的：子宫腺肌病是异常子宫出血（AUB）的常见原因，痛经,和骨盆疼痛。明确的诊断和治疗历来是子宫切除术时的子宫组织病理学;然而，影像学的进步支持了早期诊断和随后的保守治疗.这篇综述旨在更新支持保留子宫的证据，以临床结果为重点的程序性管理选择。
结果：子宫动脉栓塞（UAE），射频消融(RFA),高强度聚焦超声（HIFU），经皮微波消融(PMWA),和腺肌瘤切除术是微创干预措施，被证明可有效减少子宫腺肌病引起的AUB和痛经。症状的改善与子宫体积的减少有关。鉴于症状复发率和再干预的总体较低，研究支持使用替代治疗方案。联合治疗可能比单一治疗更有效。
结论：本综述为子宫腺肌病的替代治疗方案的使用提供了当前的证据。在美国，获得消融疗法的机会有限，而且主要是标签外的，由于缺乏FDA的批准。需要高质量的前瞻性和随机对照试验，以进一步描述治疗比较。功效,安全,和这些治疗的理想患者选择。需要更多的数据来评估那些希望将来生育的人的安全性和实用性。
结果：子宫动脉栓塞（UAE），射频消融(RFA),高强度聚焦超声（HIFU），经皮微波消融(PMWA),和腺肌瘤切除术是微创干预措施，被证明可有效减少子宫腺肌病引起的AUB和痛经。症状的改善与子宫体积的减少有关。鉴于症状复发率和再干预的总体较低，研究支持使用替代治疗方案。联合治疗可能比单一治疗更有效。
结论：本综述为子宫腺肌病的替代治疗方案的使用提供了当前的证据。在美国，获得消融疗法的机会有限，而且主要是标签外的，由于缺乏FDA的批准。需要高质量的前瞻性和随机对照试验，以进一步描述治疗比较。功效,安全,和这些治疗的理想患者选择。需要更多的数据来评估那些希望将来生育的人的安全性和实用性。
