Adenomyosis: controversies and unresolved issues

Abstract

Despite more than one and a half centuries of investigation, adenomyosis remains an unresolved issue for both clinicians and pathologists. Persistent controversies surround its terminology, classification, and diagnostic criteria. Of particular note are fundamental discrepancies in the definition and classification of adenomyosis introduced in the updated International Classification of Diseases (ICD-11) compared with its previous revision (ICD-10). The lack of a unified classification system integrating both clinical and pathomorphological principles has led to groundless overdiagnosis of the condition, with reported prevalence rates of adenomyosis reaching up to 80%. A literature search was conducted using the key words “adenomyosis” and related terms (epidemiology, classification, diagnosis, treatment) in the PubMed, MEDLINE, Embase, and Cochrane Library databases, with emphasis on full-text publications. All selected studies (n = 96) underwent rigorous critical analysis. Particular attention was paid to organ preservation strategies for the management of adenomyosis in reproductive-aged patients. Key words: adenomyosis, terminology, epidemiology, classification, diagnosis, organ preservation treatment, dienogest