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J Obstet Gynaecol Res 2021 Jun 21. Epub 2021 Jun 21.

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.

Aims: The most common symptoms of adenomyosis include heavy menstrual bleeding and dysmenorrhea. A variety of medical or surgical techniques are utilized for the treatment of adenomyosis, but there are currently no specific treatment guidelines and best practice recommendations for management. The aim of this study is to summarize current treatment strategies for women with symptomatic adenomyosis in a single-center university hospital in order to provide reliable information for developing treatment algorithms. Read More

Int J Hyperthermia 2021 ;38(1):948-962

School of Biomedical Engineering, Health Science Center, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China.

Objective: To evaluate the clinical effects of image-guided thermal ablation for the treatment of symptomatic adenomyosis (AD).

Data Sources: We searched PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov and Google Scholar for literature from January 2000 to September 2020. Read More

J Coll Physicians Surg Pak 2021 Jun;30(6):719-721

Department of Gynae Unit 1, Jinnah Hospital, Lahore, Pakistan.

Atypical polypoid adenomyoma (APAM) is a rare polypoidal benign tumor of uterus, which usually presents with irregular vaginal bleeding in women of reproductive age. It has the potential of malignant transformation but does not metastasise. It may coexist with endometrial hyperplasia and adenocarcinoma; and so, is usually misdiagnosed. Read More

Reprod Biol Endocrinol 2021 Jun 4;19(1):84. Epub 2021 Jun 4.

Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan.

Background: Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. Read More

Am J Obstet Gynecol 2021 May 28. Epub 2021 May 28.

Department of Obstetrics and Gynecology, Stanford University School of Medicine, California, USA.

Background: Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate.

Objective: To study the clinical, anatomical and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy.

Study Design: This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Read More

Ultrason Imaging 2021 May 26:1617346211017462. Epub 2021 May 26.

Amsterdam UMC Locatie De Boelelaan, Amsterdam, The Netherlands.

Uterine disorders are often presented with overlapping symptoms. The microvasculature holds specific information important for diagnosing uterine disorders. Conventional sonography is an established diagnostic technique in gynecology, but is limited by its inability to image the microvasculature. Read More

Minerva Obstet Gynecol 2021 Jun;73(3):354-361

Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy.

Background: Adenomyosis has been considered for a long time a condition of advanced reproductive age. Recently, imaging techniques have allowed its diagnosis in young women. The aim of our study was to compare adenomyosis in early (18-35) and advanced (>35) reproductive age (ERA vs. Read More

Minerva Obstet Gynecol 2021 Jun;73(3):290-303

Faculty of Medicine, University of Paris, Paris, France.

Endometriosis and adenomyosis are two frequent diseases that impair women's quality of life by causing pain and infertility. Both endometriosis and adenomyosis are heterogeneous diseases that manifest as different forms. Adenomyosis may be described as diffuse adenomyosis, focal adenomyosis especially of the outer myometrium and cystic adenomyoma. Read More

Orv Hetil 2021 05 2;162(18):690-695. Epub 2021 May 2.

3 Eastern Virginia Medical School, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Norfolk, VA, United States of America.

Összefoglaló. Az ultrahang-elasztográfia az elmúlt évek során egyre növekvő figyelmet kapott a lágyszövetek elaszticitásának vizsgálatában. A módszer használatát az teszi szükségessé, hogy egyes, a mechanikai tulajdonságaikban különböző szövetek hasonló echogenitásúak lehetnek, valamint hogy egy adott szövet megváltozott struktúrája vagy mechanikai tulajdonsága nem minden esetben jár együtt a szövet hagyományos ultrahangképének megváltozásával. Read More

J Pediatr Adolesc Gynecol 2021 Apr 25. Epub 2021 Apr 25.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.

Background: Obstructed Müllerian anomalies in adolescents can be grouped into complete outflow obstruction or unilateral outflow obstruction. The challenge with unilateral obstructions is that diagnosis can be delayed for weeks to years, as menstruation occurs normally through the patent side and thus obstruction is often not initially considered in the differential diagnosis.

Cases: In this case series, we present 3 unusual and challenging cases of unilateral Müllerian obstructions in adolescent female patients, along with strategies for diagnosis and management. Read More

J Obstet Gynaecol Res 2021 Apr 27. Epub 2021 Apr 27.

Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan.

Aims: The purpose of this study is to first investigate the correlation between image features and histological findings and the clinical severity of adenomyosis; second, search for imaging features to assess the type and locoregional extension of the disease; and finally, discuss the notation of image-based classification.

Methods: This paper combines a review of the literature on adenomyosis with a series of cases who underwent surgery at Nara Medical University Hospital.

Results: Currently, there has been a lack of clear, clinically relevant, and internationally acceptable definition and histological classification due to its diverse phenotype. Read More

Minerva Obstet Gynecol 2021 Apr 27. Epub 2021 Apr 27.

Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy -

Introduction: Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. Read More

Hum Reprod 2021 05;36(6):1574-1589

Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Study Question: Is there any change in the distribution of microvilli and microtubules in the apical endometria of women with adenomyosis?

Summary Answer: We observed microvilli damage in the apical endometria and an axonemal alteration characterized by abnormal distribution of longitudinal bundles of microtubules within microvilli in women with adenomyosis.

What Is Known Already: Human adenomyosis has a negative impact on female fertility. Abnormal utero-tubal sperm transport, tissue inflammation and toxic effect of chemical mediators have been proposed as contributing factors. Read More

Eur J Obstet Gynecol Reprod Biol 2021 Jun 14;261:29-33. Epub 2021 Apr 14.

Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.

Objectives: The aim of this study was to compare the accuracy of seven classical Machine Learning (ML) models trained with ultrasound (US) soft markers to raise suspicion of endometriotic bowel involvement.

Materials And Methods: Input data to the models was retrieved from a database of a previously published study on bowel endometriosis performed on 333 patients. The following models have been tested: k-nearest neighbors algorithm (k-NN), Naive Bayes, Neural Networks (NNET-neuralnet), Support Vector Machine (SVM), Decision Tree, Random Forest, and Logistic Regression. Read More

Fertil Steril 2021 Apr 14. Epub 2021 Apr 14.

Medical Research Council Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom. Electronic address:

Objective: To study the impact of the progesterone receptor modulator (PRM), ulipristal acetate (UPA), on endometrial morphology and function.

Design: Cross-sectional.

Setting: University Research Institute. Read More

Case Rep Obstet Gynecol 2021 29;2021:5512951. Epub 2021 Mar 29.

Department of Obstetrics and Gynecology, Kumamoto Rosai Hospital, Kumamoto 866-8533, Japan.

Lipomatous tumors are rare among uterine mesenchymal tumors. Due to their rarity, information on the clinical development and histological origin are lacking. We report a pure uterine lipoma and present a review of the relevant literature. Read More

Fertil Steril 2021 Jul 11;116(1):243-254. Epub 2021 Apr 11.

Université de Paris, Faculty of Medicine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital universitaire Paris Centre, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine, Cochin University Hospital Center, Paris, France; Department 3I "Infection, Immunité et inflammation," Cochin Institute, Institut national de la santé et de la recherche médicale U1016, Paris, France.

Objective: To determine whether the adenomyosis phenotype affects the proton nuclear magnetic resonance (H-NMR)-based serum metabolic profile of patients.

Design: Cohort study.

Setting: University hospital-based research center. Read More

Fertil Steril 2021 Jul 8;116(1):269-271. Epub 2021 Apr 8.

Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.

Objective: To describe the anatomic and technical highlights of a novel nerve-sparing surgery in deep endometriosis (DE) using near-infrared (NIR) fluorescence technology and indocyanine green (ICG).

Design: Stepwise demonstration of this method with narrated video footage.

Setting: An urban general hospital. Read More

iScience 2021 Apr 2;24(4):102258. Epub 2021 Mar 2.

Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.

The fundamental morphology of the endometrial glands is not sufficiently understood by 2D observation because these glands have complicated winding and branching patterns. To construct a large picture of the endometrial gland structure, we performed tissue-clearing-based 3D imaging of human uterine endometrial tissue. Our 3D immunohistochemistry and layer analyses revealed that the endometrial glands form a plexus network in the stratum basalis and expand horizontally along the muscular layer, similar to the rhizome of grass. Read More

Radiographics 2021 May-Jun;41(3):929-944. Epub 2021 Mar 26.

From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-340, Portland, OR 97239.

Adenomyosis is a common benign uterine disorder in which ectopic endometrial glands extend into the myometrium. Adenomyosis is increasingly diagnosed in young women, affecting 20%-35% of women of reproductive age. Features of adenomyosis can be seen with either US or MRI, especially with newer imaging technology. Read More

J Gynecol Obstet Hum Reprod 2021 Mar 20;50(7):102114. Epub 2021 Mar 20.

Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan. Electronic address:

Introduction: Although various perinatal complications have been reported to be increased in the pregnant patients with adenomyosis, it is not clear what type of patients with adenomyosis is more likely to cause obstetric complications. In this study, we focused on the positional relationship between the placenta and adenomyosis lesion in evaluating perinatal prognosis of pregnant patients with adenomyosis.

Material And Methods: This retrospective cohort study was carried out between 1 January 2005 and 31 December 2019 in a single institution. Read More

Fertil Steril 2021 Jul 20;116(1):272-274. Epub 2021 Mar 20.

Reproductive Medicine Department, Instituto Bernabeu, Alicante, Spain.

Objective: To study uterine peristalsis using step-by-step 4-dimensional (4D) ultrasound assessment video, explore its relationship with progesterone levels in a select in vitro fertilization population, and assess the reproducibility of the technique.

Design: Four-dimensional uterine ultrasound and a retrospective analysis of outcomes in relation with progesterone levels. The videos were also analyzed by a senior doctor, junior doctor, and a nurse for their reproducibility. Read More

Fertil Steril 2021 Apr 6;115(4):1084-1086. Epub 2021 Mar 6.

Department of Radiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Objective: To describe the management and the fertility-enhancing potential of surgery in an infertile patient with deep-infiltrating endometriosis and adenomyosis externa.

Design: Video case report.

Setting: Minimally invasive and robotic gynecologic surgery unit of a university hospital. Read More

Biol Reprod 2021 Mar 19. Epub 2021 Mar 19.

Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, The United States.

Emerging evidence supports the notion that inflammation fosters the development of common benign gynecologic disorders, including uterine leiomyoma, endometriosis, and adenomyosis. Numerous cytokines, chemokines, and growth and transcription factors have indisputable roles in the establishment and maintenance of benign gynecologic disorders by initiating complex cascades that promote proliferation, angiogenesis, and lesion progression. The interaction between inflammation and benign gynecologic disorders is orchestrated by a plethora of factors, including sex steroids, genetics, epigenetics, extracellular matrix, stem cells, cardiometabolic risk factors, diet, vitamin D, and the immune system. Read More

Reprod Sci 2021 Mar 16. Epub 2021 Mar 16.

Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.

The current study was designed to evaluate the relationship between adenomyosis and its subtypes with endometriotic lesions (ovarian endometrioma (OMAs) and posterior deep infiltrative endometriosis (DIE)), to examine the probability of existence of a common cause of these mysterious diseases, and to evaluate the accuracy, sensitivity, and specificity of both transvaginal ultrasonography (TVS) and MRI in diagnosis of adenomyotic uterus. In this retrospective cross-sectional study, we selected 154 women with coexistence of endometriosis and adenomyosis according to their imaging, intraoperative, or pathological findings who were nominated for laparoscopic surgery. Eighty-six patients with just DIE resection without LH (laparoscopic hysterectomy) (group 1), and 68 patients with LH + DIE resection (group 2). Read More

Acta Obstet Gynecol Scand 2021 Mar 7. Epub 2021 Mar 7.

Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, the Netherlands.

Introduction: Magnetic resonance imaging (MRI) diagnosis of adenomyosis is considered the most accurate non-invasive technique, but remains subjective, with no consensus on which diagnostic parameters are most accurate. We aimed to systematically review the literature on how adenomyosis can be objectively quantified on MRI in a scoping manner, to review the diagnostic performance of these characteristics compared with histopathological diagnosis, and to summarize correlations between measures of adenomyosis on MRI and clinical outcomes.

Material And Methods: We searched databases Pubmed, Embase, and Cochrane for relevant literature up to April 2020 according to PRISMA guidelines. Read More

Gynecol Oncol Rep 2021 May 19;36:100733. Epub 2021 Feb 19.

Department of Pathology, Kindai University Faculty of Medicine, Osakasayama-city, Osaka, Japan.

Diaphragmatic endometriosis is extremely rare. Although endometriosis is considered generally benign, malignant transformation of endometriosis was reported in 1925. Multiple studies have since described clear cell carcinoma (CCC) or endometrioid carcinoma arising from ovarian endometriosis. Read More

Eur J Obstet Gynecol Reprod Biol 2021 Apr 23;259:133-139. Epub 2021 Feb 23.

Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università Degli Studi Dell'Insubria, Varese, Italy.

Objectives: This study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital to determine if the use of formal guidelines and a standardised surgical technique would increase the rate of vaginal hysterectomy (VH) and result in an overall decline in open abdominal hysterectomy (AH).

Study Design: All women admitted between July 2001 and December 2014 for hysterectomy due to benign conditions, meeting the guidelines criteria (vaginally accessible uterus, uterus ≤ 12 weeks size or ≤ 280 g on ultrasound examination and pathology confined to the uterus) were included. The surgical route was determined using the Unit surgical decision tree algorithm. Read More

J Comput Assist Tomogr 2021 Mar-Apr 01;45(2):224-231

From the Department of Gynaecology, General Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin.

Objective: The objective of this study was to investigate the efficacy of high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist or levonorgestrel-releasing intrauterine system (LNG-IUS) in treating dysmenorrhea in patients with severe adenomyosis.

Methods: A retrospective analysis was performed on 243 patients diagnosed with severe adenomyosis. Patients were divided into H (received HIFU alone), H-G (received HIFU combined with gonadotropin-releasing hormone agonist), and H-L (received HIFU combined with LNG-IUS) groups. Read More

JBRA Assist Reprod 2021 Apr 27;25(2):303-309. Epub 2021 Apr 27.

Department of Urology, Pontifical Catholic University of Campinas, Campinas (SP), Brazil.

Adenomyosis is a gynecological condition, which is characterized by stromal and glandular endometrial tissue infiltration inti the myometrium, resulting in an increase of uterine volume. The etiology of adenomyosis is presently unknown, but some theories assist us in understanding its pathogenesis and natural history. Clinical manifestations are increased menstrual flow and dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and dyspareunia. Read More