Surgical Options
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Explore procedures for managing adenomyosis, from uterus-sparing options to hysterectomy, with clear guidance on candidacy, risks, recovery, fertility considerations, and how to partner with your care team.
Overview
Surgical care for adenomyosis is tailored to symptoms, reproductive goals, and how widely the uterine muscle is involved. Imaging—especially MRI and high‑quality ultrasound—helps distinguish focal adenomyomas from diffuse disease and guides the choice between uterus‑sparing procedures and definitive hysterectomy. When adenomyosis coexists with endometriosis, the plan may be adjusted to address both conditions comprehensively; see Imaging & Diagnosis (MRI, Ultrasound) and Endometriosis for context.
Uterus‑sparing options include laparoscopic adenomyomectomy (adenomyoma enucleation) for localized disease, using layered reconstruction to preserve strength for future pregnancy. For diffuse involvement, symptom‑focused options such as debulking, high‑intensity focused ultrasound (HIFU/MRgFUS), or uterine artery embolization (UAE) may help pain and bleeding but have uncertain fertility outcomes. Hysterectomy remains the most reliable solution for those finished with childbearing, with minimally invasive approaches generally enabling quicker recovery and ovarian preservation when appropriate. Learn how candidacy, risks, recovery, and future pregnancy planning intersect across choices; see Focal Adenomyosis, Diffuse Adenomyosis, and Fertility Considerations.
How do specialists choose between uterus‑sparing surgery and hysterectomy for adenomyosis?
Decisions hinge on symptom severity, desire for future pregnancy, age, and whether disease is focal or diffuse on imaging. Focal adenomyosis often suits adenomyomectomy, while extensive diffuse disease more often leads to symptom‑focused procedures or hysterectomy; see Focal Adenomyosis and Diffuse Adenomyosis.
Can adenomyomectomy improve fertility?
In carefully selected patients with focal disease, adenomyomectomy can reduce pain and may improve implantation and pregnancy rates. It creates a uterine scar, so conception is typically delayed for healing and delivery is often planned by cesarean with close obstetric monitoring; see Fertility Considerations.
Is endometrial ablation a good option for adenomyosis?
Ablation targets the endometrium, not the adenomyotic tissue within the muscle, so outcomes are often poor and pain can worsen. It is generally not recommended, especially for those who may want future pregnancy.
What about uterine artery embolization or HIFU if I hope to conceive?
UAE and HIFU can relieve bleeding and pain, particularly when surgery is high‑risk or fertility is not a goal. Data on fertility and pregnancy after these procedures are limited, and some studies suggest higher obstetric risks after UAE, so they are usually reserved for those not pursuing pregnancy or used after thorough counseling.
Will my ovaries be removed during hysterectomy for adenomyosis?
Adenomyosis is a uterine disease, so ovaries are often preserved to avoid surgical menopause unless another condition warrants removal. If endometriosis is present, the surgical plan may include additional treatment to reduce persistent pain; see Endometriosis.
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