Article Sidebar
Main Article Content
Abstract
Background: Adenomyosis is a benign gynecological condition that can cause significant morbidity, including dysmenorrhea, menorrhagia, and pelvic pain. Hysterectomy has been the traditional treatment for adenomyosis, but uterine-sparing procedures (USPs) are increasingly being considered, especially for women who desire fertility preservation. This meta-analysis compared the effectiveness of USPs versus hysterectomy for adenomyosis, focusing on patient-reported outcomes (PROs) and fertility preservation.
Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024, comparing USPs (e.g., laparoscopic or hysteroscopic adenomyomectomy, uterine artery embolization) with hysterectomy for adenomyosis. Studies reporting PROs (dysmenorrhea, menorrhagia, pelvic pain, quality of life) and fertility outcomes (pregnancy rate, live birth rate) were included. Random-effects models were used to pool data and assess heterogeneity.
Results: Six studies (n = 1248 patients) met the inclusion criteria. USPs were associated with significantly lower rates of major complications (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54, p<0.0001) and shorter hospital stays (mean difference -2.73 days, 95% CI -3.29 to -2.17, p<0.0001) compared to hysterectomy. PROs, including dysmenorrhea, menorrhagia, and pelvic pain, significantly improved in both groups, with no significant difference between USPs and hysterectomy. Fertility preservation was significantly higher in the USP group (OR 3.9, 95% CI 3.02-5.03, p<0.0001).
Conclusion: USPs offer a safe and effective alternative to hysterectomy for adenomyosis, with comparable improvements in PROs and significantly higher rates of fertility preservation. This information can guide clinicians and patients in shared decision-making regarding the optimal treatment approach.
Keywords
Article Details
As our aim is to disseminate original research article, hence the publishing right is a necessary one. The publishing right is needed in order to reach the agreement between the author and publisher. As the journal is fully open access, the authors will sign an exclusive license agreement.
The authors have the right to:
- Share their article in the same ways permitted to third parties under the relevant user license.
- Retain copyright, patent, trademark and other intellectual property rights including research data.
- Proper attribution and credit for the published work.
For the open access article, the publisher is granted to the following right.
- The non-exclusive right to publish the article and grant right to others.
- For the published article, the publisher applied for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
