The diagnoses of AUB-E and AUB-A are often confused, since the histological confirmation of adenomyosis is not possible by conservative measures¹. Consequently, endometrial ablation is often used as a treatment modality, although the presence of adenomyosis may lead to a higher failure rate of ablation – up to 31%, with the diagnosis only made after further intervention such as hysterectomy is performed for women with ongoing bleeding symptoms².

The use of diagnostic imaging such as ultrasound may be of some benefit in determining extensive adenomyoisis, although more subtle glandular infiltration of the myometrium is not always as easy to demonstrate³ with sensitivity and specificity of 80.8% and 61.4% respectively⁴. Superficial disease in the subendometrial layer may be adequately and completely treated by second generation ablation procedures, although the mechanism for these devices is to not infiltrate the myometrium deeply. For known deep disease, then resection as a primary modality may offer better post-operative outcomes, with sonographic or laparoscopic control both described as options for a deeper ablation procedure^5,6.

Even in the absence of resective ablation, the technique may still be successful and therefore remains an option for women not wanting to undergo uterine removal. There is also the possibility of combination medical and surgical treatments (including progesterone containing IUD) to further decrease symptoms.