Non-surgical Treatment of Adenomyosis

Uterine-sparing excisional surgical techniques for adenomyosis are complex, carry significant risks, and after all have substantial recurrence rates. Consequently, there has been a trend towards adopting non-surgical treatments. This narrative review outlines the latest in non-surgical treatments for adenomyosis, highlighting their significance in managing this condition and stresses the importance of further research, especially concerning long-term outcomes and fertility implications. Emerging evidence suggests that non-surgical techniques for the treatment of adenomyosis offer promising alternatives to traditional uterus-conserving surgery. LNG-IUS is recommended as the primary management strategy for adenomyosis. In our clinical evaluation, a pretreatment with GnRH-analogs, HIFU, or UAE prior to LNG-IUS insertion in enlarged uteri may mitigate treatment failure risks, notably device expulsion. Concurrently, post-intervention LNG-IUS application post non-surgical modalities can diminish recurrence probability. In large uteri with presence of multiple uterine fibroids, UAE may be preferable compared to thermal ablation procedures especially if there is no wish for pregnancy or comorbidities not allowing for a hysterectomy. For focal adenomyosis, especially when prioritizing fertility preservation, RFA may be considered due to its precise targeting, available data on pregnancy outcomes, and ease of incorporation into gynecological practice. In cases of localized disease of the anterior wall of the uterus without prior surgeries and no suspicion of concurrent endometriosis, HIFU can be favored.