Short summary

Adenomyosis is a benign condition where endometrial glands and stroma infiltrate the myometrium, often linked to extrauterine endometriosis. It can cause uterine enlargement, dysmenorrhea, menorrhagia, dyspareunia, and subfertility. This study assesses the impact of hormonal therapy on adenomyosis-related pain in MRI-verified cases by analyzing the PRO-endometriosis questionnaire before treatment and after six months for the purpose of optimizing conservative treatment.

Rationale

Adenomyosis is a benign condition marked by the presence of endometrial glands and stroma within the uterine myometrium, primarily affecting women of reproductive age. It is often linked to endometriosis and causes symptoms like menorrhagia, dysmenorrhea, pelvic pain, dyspareunia, and infertility. The exact cause is unclear, but it is thought to stem from abnormal thickening of the junctional zone (JZ), leading to impaired fertility due to disrupted cycle-dependent contractions. Other theories include Müllerian rests, stem cell metaplasia, genetic mutations, and endometrial invagination into the myometrium. The prevalence of adenomyosis varies widely from 5% to 70%, likely due to differences in diagnostic criteria, pathologist bias and study populations. Histopathologically, adenomyosis is classified as focal or diffuse, depending on whether endometrial glands and stroma are localized or spread throughout the myometrium. While subtypes have been proposed, no universally accepted classification guidelines exist. Diagnosis is made through transvaginal ultrasonography (TVUS) or MRI, with definitive confirmation requiring histopathological evidence of endometrial glands deeper than 2.5 mm into the myometrium. Studies suggest MRI may be as effective, or superior, to TVUS in diagnosing adenomyosis. Hysterectomy is typically the definitive treatment, but with no established treatment guidelines, those desiring fertility have limited conservative options. Off-label hormonal and non-hormonal treatments like GnRH agonists, LNG-IUD, combined oral contraceptives (COC), selective progesterone receptor modulators, and aromatase inhibitors a.o. are used to manage adenomyosis. The primary objective of this study is to evaluate the hypothesis that hormonal therapy effectively alleviates adenomyosis-related pain in women with MRI-verified adenomyosis. This will be assessed through an analysis of patient-reported outcomes (PROs) collected using the validated PROdata questionnaire, "PRO-endometriosis," administered at six months following treatment initiation. A clinically meaningful reduction in pain will be defined as a decrease in the Visual Analog Scale (VAS) score exceeding 3 cm. The secondary objective of this study is to evaluate the hypothesis that hormonal treatment improves quality of life. This will be assessed by analyzing patient-reported outcomes (PROs) from the "PRO Endometriosis" questionnaire, focusing on the use of pain medication, sexual health, well-being, WHO's depression scale and other symptoms related to their adenomyosis diagnosis.

Description of the cohort

Patients with MRI-verified adenomyosis, from department of Gynaecology and Obstetrics at Odense University Hospital, out patients clinic.

Data and biological material

Data will be extracted solely from the patient journals, hereby accessing PROdata questonnaires and baseline demographics a.o.

Collaborating researchers and departments

Department of Gynaecology and Obstetrics (Odense University Hospital)

• Mette Louise Hansen
• Katarina Rose Dige