Adenomyosis: clinical aspects, impact on fertility and pregnancy outcome

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Abstract


Aim. To investigate the modern condition of the problem of adenomyosis and its impact on women’s reproductive function.

Material and methods. The article presents a systematic literature review on the results of research search in electronic databases MEDLINE, PubMed, EMBASE, Cochrane Library and Elibrary.

Results. Adenomyosis is a common but insufficiently studied disease. Modern imaging methods, such as transvaginal ultrasound and MRI, make it possible to diagnose adenomyosis at the early stages of the disease and perform the organ-preserving surgery. A medical treatment of adenomyosis requires to develop a lifelong management plan, the choice depends on the woman’s age, reproductive status and clinical symptoms. Currently, there is evidence of a negative impact of adenomyosis on fertility and pregnancy outcomes. Dienogest, a 19-norsteroid derivative, is a progestin with high selectivity to progesterone receptors, it exerts a hypogonadotropic effect and an antiproliferative effect on the endometrium. A mild regime of supression of ovarian function provides adequate conditions for blood supply to the uterus before planning a pregnancy. The immunomodulating effect of progestin may be useful for implantation and fetal protection to pregnancies occurring after treatment. Dienogest treatment increases the effectiveness of IVF cycles for adenomyosis of varying severity.

Conclusion. The review summarizes the aspects of prevalence, comorbidity, risk factors, classification, mechanism of pathogenesis, clinical manifestations, diagnosis, treatment of adenomyosis, impact on fertility and pregnancy outcomes.


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About the authors

Rushania I. Gabidullina

Kazan State Medical University

Author for correspondence.
Email: ru.gabidullina@yandex.ru
ORCID iD: 0000-0002-7567-6043

Russian Federation, Kazan

D. Sci. (Med.), Prof, Kazan State Medical University

Angelina I. Kuptsova

Kazan State Medical University

Email: venerakuptsova@yandex.ru
ORCID iD: 0000-0002-4914-5206

Russian Federation, Kazan

Resident, Kazan State Medical University

Ekaterina A. Koshelnikova

City Clinical Hospital №7

Email: kiryakovatelemed@yandex.ru
ORCID iD: 0000-0003-3635-8963

Russian Federation, Kazan

gynecologist, City Clinical Hospital №7

Fikret R. Nuhbala

Kazan State Medical University

Email: nuhbala_fikret@mail.ru
ORCID iD: 0000-0002-1244-7577

Russian Federation, Kazan

Graduate Student, Kazan State Medical University

Rufat R. Bagirli

Kazan State Medical University

Email: dr.bagirli.rufat@mail.ru
ORCID iD: 0000-0002-0211-3872

Russian Federation, Kazan

Graduate Student, Kazan State Medical University

Elmira R. Mingaleva

Kazan State Medical University

Email: elmira_mutygova@mail.ru
ORCID iD: 0000-0002-6711-9079

Russian Federation, Kazan

Student, Kazan State Medical University

Endzhe A. Khaliullina

Kazan State Medical University

Email: khaliullina-endzhe@mail.ru
ORCID iD: 0000-0002-3675-6841

Russian Federation, Kazan

Student, Kazan State Medical University

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