Uterine Sparing Surgery for Diffuse Adenomyosis in Reproductive Age Women: A Prospective Controlled Study of Symptom Relief and Fertility Outcomes
Keywords:
adenomyosis, adenomyomectomy, fertility, dysmenorrhea, hysterectomy, uterus sparing, gynecologic surgeryAbstract
Adenomyosis is increasingly diagnosed in reproductive‑age women seeking uterine preservation, yet the role of conservative uterine‑sparing surgery remains controversial compared with medical therapy alone. This prospective controlled study evaluated the clinical and reproductive efficacy of uterus‑sparing adenomyomectomy plus standard medical therapy versus medical therapy alone in women with symptomatic diffuse adenomyosis wishing to retain fertility. Eighty patients were enrolled and allocated to two groups: 40 underwent conservative adenomyomectomy followed by postoperative levonorgestrel intrauterine system or dienogest (surgery group), and 40 received medical therapy alone (control group). Baseline characteristics were comparable. Primary outcomes were change in dysmenorrhea intensity (VAS, 0–10) and heavy menstrual bleeding (PBAC score) at 12 months. Secondary outcomes included spontaneous clinical pregnancy rate within 24 months and need for reintervention. At 12 months, 72.5% of women in the surgery group achieved ≥50% reduction in dysmenorrhea versus 40.0% in controls; marked improvement in heavy menstrual bleeding was also more frequent after surgery. Within 24 months, spontaneous clinical pregnancy occurred in 35.0% of operated women compared with 15.0% of controls.
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