Adenomyosis is a common gynaecologic condition defined by the presence of ectopic endometrial glands and stroma within the myometrium. It has a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhoea. However, the majority of patients are asymptomatic.
Whilst difficult to diagnose definitively, it is commonly agreed there is a loss of integrity in the junctional zone between endometrium and myometrium, which can be seen on transvaginal ultrasound and magnetic resonance imaging.
Similar to endometriosis, this is an oestrogen-dependent disease. Thus, systemic therapies that are effective for endometriosis have also been effective for the treatment of symptoms of adenomyosis. This review will discuss medical therapies for the condition including the continuous use of oral contraceptive pills, high-dose progestogens, selective oestrogen/progestogen receptor modulators, selective progesterone receptor modulators, the levonorgestrel-releasing intrauterine device, aromatase inhibitors, and gonadotrophin receptor hormone agonists.
Medical therapies can all temporarily reduce symptoms and induce regression. However, they do not allow the patient to conceive. Evidence for the use of MRgFUS, HIFU, and UAE will also be described, with their evidence base.
In summary, there are a limited number of options for the non-surgical management of adenomyosis. Hysterectomy remains the “gold stanard” and definitive treatment for the condition.