Biopsy diagnosis and conservative surgical treatment of adenomyosis

Fifteen patients with dysmenorrhoea and menorrhagia refractory to medical treatment were referred for surgical treatment. Pre-operative diagnosis of adenomyosis was suggested by vaginal ultrasound in 13 patients and was confirmed pre-operatively by myometrial biopsy in 5 and by transcervical myometrial biopsy at the time of endometrial resection in 7. Conservative surgery included endometrial resection (7), myometrial reduction by electrocautery (4), and myometrial excision (3). Marked improvement occurred in 4 of 7 patients after endometrial resection, 3 of 4 after myometrial reduction, and all of 3 having myometrial excision. Diagnosis of adenomyosis is improved by use of vaginal ultrasound and percutaneous or transcervical myometrial biopsy. Conservative surgical procedures including endometrial resection and myometrial reduction or excision may reduce the need for hysterectomy in the presence of adenomyosis.