Adenomyomectomy

Adenomyomectomy is a complex, uterus-sparing surgical procedure that we perform to specifically remove the diseased adenomyotic tissue from the uterine wall. Unlike a hysterectomy, the goal of this surgery is not removal, but reconstruction. Our primary aim is to alleviate the debilitating symptoms of the condition while carefully preserving the integrity and function of the uterus.

This procedure requires a high degree of surgical skill and a deep understanding of the unique challenges posed by adenomyosis. Our team is dedicated to providing this advanced level of care. We believe in empowering you with solutions that address your immediate health needs without sacrificing your future reproductive goals.

Do I really need surgery, or can medications be enough?

Not every woman with adenomyosis needs surgery. Some can manage symptoms with medication and maintain a normal life. But when medications fail, cause serious side effects, or cannot match the intensity of pain and bleeding, surgery becomes a real option. Surgery is not only about symptom control—it restores quality of life, protects emotional well-being, and improves energy and fertility.

Adenomyosis rarely appears alone. It often coexists with endometriosis, and both may need treatment during the same operation. When I perform excision surgery for endometriosis, I always examine the uterus closely. Adenomyosis may contribute to pain and infertility, and the surgical plan must address both. That may mean excising endometriotic lesions and treating adenomyosis with uterus-preserving surgery or, in certain cases, hysterectomy for definitive relief.

Understanding adenomyosis and the adenomyoma

To understand the surgery, it is first essential to understand the condition. Adenomyosis can present in two primary ways: diffuse or focal.

In diffuse adenomyosis, the most common form, the displaced endometrial tissue is spread widely throughout the uterine muscle. This makes it very difficult to separate the healthy tissue from the diseased tissue.

In focal adenomyosis, the diseased tissue is concentrated in one or more specific locations, forming a distinct, localized mass. This mass is known as an adenomyoma. An adenomyoma can feel and look very much like a uterine fibroid, which often leads to misdiagnosis. However, it is fundamentally different. A fibroid is a benign tumor that typically grows with a clear capsule, making it relatively simple to “shell out” from the uterine wall. An adenomyoma has no capsule. Its edges are indistinct, blending directly into the surrounding healthy muscle.

Is hysterectomy my only option?

When adenomyosis occurs together with endometriosis—as it often does—we can combine surgeries. In the same operation, we may perform excision of endometriosis along with either adenomyomectomy to preserve the uterus or hysterectomy if definitive treatment is the best choice. This comprehensive approach addresses pain, bleeding, and infertility in a single, carefully planned surgery.

Many women hesitate at the thought of hysterectomy, especially if they want to preserve fertility. Uterus-preserving approaches are not only possible but realistic in carefully chosen cases. Advances in surgical technique allow us to remove adenomyotic tissue or reduce its impact while preserving the uterus.

When should surgery be considered?

Surgery becomes an option when symptoms grow so severe that they disrupt daily life. This includes heavy bleeding that causes anemia, pelvic pain that limits activity, or infertility directly related to the disease. If symptoms remain mild, respond to medication, or if other health conditions make surgery risky, waiting may be the better option. The decision must stay personal, weighing how much the disease disrupts life against the potential risks and benefits of surgery.

What uterus-preserving options are available?

Several procedures offer alternatives to hysterectomy. One option is uterine artery embolization (UAE), a minimally invasive technique that blocks blood supply to adenomyotic tissue. Over time, the tissue shrinks and symptoms improve. Another option is adenomyomectomy, a targeted surgery that removes diseased areas while preserving the rest of the uterus. This option is especially valuable for women who want to preserve fertility.

Adenomyomectomy may not eliminate adenomyosis completely, and the disease can recur. Because the uterus is reconstructed after tissue removal, women who later become pregnant need close monitoring. Still, the true value of this surgery lies in its ability to control symptoms while avoiding hysterectomy.

Adenomyomectomy requires advanced skill to excise diseased tissue while protecting healthy uterine muscle. In expert hands, it remains one of the most effective uterus-preserving options for women who want lasting relief without losing their uterus.

How effective are these procedures, and what are the risks?

Effectiveness varies from woman to woman. UAE provides strong relief for many, but symptoms often return after several years, and ovarian function may be affected. Adenomyomectomy reduces pain and improves quality of life, but because it involves reconstruction of the uterus, there are risks of scarring and complications in future pregnancies. Endometrial ablation, which destroys the uterine lining, can help reduce heavy bleeding but does not treat deep pain and is unsuitable for women who wish to conceive.

What about hysterectomy—what should I know?

For women who no longer plan to have children or who want a permanent solution, hysterectomy remains the most effective treatment. Today, most hysterectomies are performed laparoscopically or robotically, using small incisions that allow faster recovery and less discomfort. When adenomyosis is combined with severe endometriosis, especially in cases of frozen pelvis where scar tissue fixes organs together, the surgery can be particularly challenging. These cases demand advanced expertise to free pelvic structures safely and complete the procedure.

How does surgery affect fertility and pregnancy?

Adenomyosis often coexists with endometriosis. In these cases, complete excision surgery for endometriosis creates a healthier environment for conception. Removing inflammatory lesions, restoring pelvic anatomy, and freeing the ovaries, fallopian tubes, and bowel from adhesions improves the conditions for fertility. When this is combined with uterus-preserving treatment of adenomyosis, the pelvic environment improves further. Many women experience better pregnancy outcomes after such comprehensive surgery, especially when both conditions are treated together.

Fertility results, however, still vary. Reconstructive procedures for adenomyosis may improve the uterine environment but also carry risks such as scarring, miscarriage, or preterm birth. While these risks exist, a carefully planned, expertly executed combined surgical approach remains one of the most effective ways to restore pelvic health and optimize the chances for conception.

Is adenomyomectomy the same as hysterectomy?

No, adenomyomectomy is not the same as hysterectomy because it removes only diseased tissue and preserves the uterus. A hysterectomy involves the complete removal of the uterus, which eliminates the possibility of future pregnancy. In contrast, adenomyomectomy targets focal adenomyosis and is often chosen by women who wish to maintain fertility. While both surgeries aim to relieve symptoms like pain and heavy bleeding, their outcomes and purposes differ significantly. Adenomyomectomy is more conservative and suitable for localized disease. Recovery time, risks, and long-term effects also vary between the two procedures.

Adenomyomectomy versus other treatments

It is important to understand where adenomyomectomy fits among the other treatment options.

Hysterectomy is the only 100 percent definitive cure for adenomyosis, as it removes the entire uterus. However, it results in the permanent loss of fertility and the end of menstruation. It is the last resort for women who have completed their families or do not wish to preserve their uterus.

Medical Management includes hormonal treatments like birth control pills or a progestin-releasing IUD (Mirena). These treatments are excellent for managing the symptoms of pain and bleeding. They do not, however, remove the adenomyoma. They are a great first-line option, but if they fail or you cannot tolerate them, surgery becomes the next step.

Uterine Artery Embolization (UAE) is a procedure that blocks the blood supply to the uterus. While very effective for fibroids, its role in adenomyosis is less predictable and is generally not the recommended path for women seeking future fertility.

Adenomyomectomy is the only procedure that removes the source of the problem (the adenomyoma) while preserving the uterus for future pregnancy.