Medical treatment of adenomyosis is aimed at controlling the symptoms and not the disease anatomically. The principle of treatment is, as with endometriosis, to block ovulation and suppress menstruation, allowing the endometrium to shrink or microhemorrhages to disappear. The results of medical treatment are nevertheless very variable, with bleeding and pain persisting despite well-directed treatment.
Surgical treatment is either conservative (conservation of the uterus) or radical (hysterectomy or removal of the uterus). Conservative techniques aim to destroy the areas of adenomyosis in the most targeted way possible so as to reduce symptoms.
In diffuse forms of adenomyosis, some endometrial destruction techniques can destroy localized microcysts in the myometrium if not very deep. However, this technique is not recommended for women who wish to become pregnant since it also destroys healthy endometrium. In addition, it can also leave the deeper foci in place, which may cause a recurrence of symptoms in the short or medium term.
In forms of focal adenomyosis, it is possible to envisage removal of the original site, while preserving the uterus, using a technique similar to that used for fibroids. The Osada technique is one such technique, generally performed by opening the abdomen (laparotomy). The exeresis is often incomplete but allows improvement in symptoms and pregnancy for women who wish to conceive.
The most effective surgery for adenomyosis remains hysterectomy, resulting in the elimination of bleeding and an improvement in pain. It is of course reserved for patients who no longer wish to become pregnant and after failure of medical treatments.
In women who wish to conceive, surgery most often concerns the endometriosis only, while adenomyosis remains in place. This situation can lead to persistent dysmenorrhea, deep dyspareunia or intermenstrual pain. A hysterectomy can be performed in a second instance, once pregnancy(s) has been achieved and significant improvement in pain and quality of life