EC Gynaecology

Adenomyosis, characterized by the presence of ectopic endometrial tissue within the myometrium, presents a significant clinical challenge due to its various manifestations and major impact on women's health. This narrative review provides a comprehensive overview of adenomyosis, focusing on its pathogenesis, clinical presentation, diagnosis, and management. The pathogenesis of adenomyosis involves intricate interactions between hormonal, and environmental factors, leading to the invasion of endometrial tissue into the myometrium. Various hypotheses, including metaplasia, invagination, and stem cell theory, have been proposed to understand adenomyosis development. Adenomyosis presents with a variety of symptoms, including dysmenorrhea, menorrhagia, pelvic pain, dyspareunia, and infertility. The variability in symptomatology highlights the importance of a multidisciplinary approach to diagnosis and management. Accurate diagnosis of adenomyosis is achieved by a combination of clinical history, physical examination, and imaging modalities. Transvaginal ultrasound and magnetic resonance imaging (MRI) are commonly used for detecting adenomyotic lesions, although challenges remain in standardizing diagnostic criteria and differentiating adenomyosis from other uterine pathologies. Treatment strategies for adenomyosis aim to alleviate symptoms, preserve fertility, and improve quality of life. Medical management includes analgesics, hormonal therapies, and aromatase inhibitors. Surgical interventions, including adenomyomectomy and hysterectomy, may be considered for individuals seeking definitive treatment. Future research directions in adenomyosis should prioritize further clarifying its pathogenesis, identifying biomarkers for early detection and prognosis, and developing targeted therapies. Standardization of diagnostic criteria, optimization of imaging techniques, and multidisciplinary approach are essential for advancing research on adenomyosis and improving patient care. In conclusion, this narrative review provides a comprehensive overview of adenomyosis, highlighting its complex pathogenesis, clinical presentation, diagnostic challenges, and management strategies.

 Keywords: Magnetic Resonance Imaging (MRI); Adenomyosis; Stem Cell Theory

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