Adenomyosis · Medical vs Uterus-Sparing vs Hysterectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Symptoms + fertility wish
   Symptom severity? Preserve uterus/fertility?
   • Symptomatic, try medical/conservative first → Medical/conservative
   • Symptomatic, wants to preserve uterus/fertility → Preserve uterus → lesion excision/UAE/HIFU
   • Symptomatic, completed childbearing/wants definitive cure → Completed childbearing → hysterectomy
2. [End] Medical/conservative
   Medical: LNG-IUS (Mirena) preferred, GnRH agonist (preoperative/short-term), oral progestin/COC, tranexamic acid for menorrhagia; failure/intolerance → surgery.
3. [End] Preserve uterus → lesion excision/UAE/HIFU
   Uterus-sparing → adenomyomectomy (diffuse disease resects incompletely and recurs easily), uterine artery embolization (UAE), HIFU; weigh recurrence against fertility and uterine rupture risk in pregnancy.
4. [End] Completed childbearing → hysterectomy
   Completed childbearing/wants definitive cure → hysterectomy (definitive cure); abdominal/laparoscopic/vaginal by uterine size and surgeon.

Source guidelines & references

• Adenomyosis management (ACOG; ESHRE endometriosis/adenomyosis)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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