Uterine adenomyoma-what we know, and what we don't know: a narrative review

Background and Objective: Adenomyosis is a benign disorder of the uterus characterised by infiltration of endometrial glands and stroma into the myometrium. It is present in a significant proportion of women presenting with heavy menstrual bleeding (HMB) and infertility. Adenomyosis is a heterogeneous disease that can present in different configurations in the myometrium. It is considered diffuse when deposits of endometrial glands and stroma are distributed throughout the myometrium, or focal when there are circumscribed aggregates. Uterine adenomyomas are areas of focal adenomyosis with hypertrophy of surrounding myometrium. They were first described in 1896, but have since received relatively little attention and available literature on this topic is sparse. In this narrative review we address what is known about uterine adenomyomas, and what is not yet known. Methods: Medline and EMBASE were searched using MeSH or index terms for the following key words: "adenomyosis" and "adenomyoma". Key Content and Findings: This narrative review summarizes our current knowledge of adenomyomas, including their epidemiology, pathophysiology, clinical presentation and management. The involvement of adenomyosis in HMB is well established but its impact on fertility and fertility treatment outcome is less clear. The current evidence base suggests that adenomyosis in its more severe forms impairs fertility and reduces chances of success with assisted reproduction treatments. Conclusions: Current research is limited regarding the effect of adenomyosis on fertility, but available data suggests it has a detrimental impact on natural fertility and fertility treatment outcomes. Its involvement in HMB is better established. Historically treatment was limited to hysterectomy but the contemporary approach includes a number of medical and surgical options to preserve fertility and the uterus.