Adenomyosis: clinicist’s tactics through the prism of domestic and international guidelines

М.Р. Оразов
In: Clinical review for general practice · 2025 · vol. 6(2) · doi:10.47407/kr2025.6.2.00564 · W4413760492
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This review analyzes domestic and international guidelines to distinguish adenomyosis as a separate disorder from endometriosis, recommending dienogest monotherapy or combined oral contraceptives for long-term symptom management.

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This review examines the clinical management of adenomyosis through the lens of domestic and international guidelines, noting its classification as a distinct disorder separate from endometriosis in the ICD-11. The authors highlight that while both conditions share pathogenic similarities, recent guidelines from the Asian Society of Endometriosis and Adenomyosis and the Society of Obstetricians and Gynaecologists of Canada treat them independently. A key finding is that dienogest, either as monotherapy or in combination with oral contraceptives, represents a highly suitable option for long-term symptom management in patients requiring reliable contraception. This paper is centrally about adenomyosis — specifically focusing on diagnostic criteria and pharmacological treatment strategies derived from major international clinical guidelines.

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Abstract

Today, both adenomyosis and endometriosis are at the forefront of scientific debate. The kinship of adenomyosis and endometriosis at first glance still raise no doubts, since there is reliable scientific evidence of the fact that the pathogenesis of these disease entities has much in common. However, despite the continuing similarity, adenomyosis is currently considered as a separate disorder; in the updated International Classification of Diseases 11th Revision adenomyosis is not included in the endometriosis section (GA10 Endometriosis), but allocated to a separate category (GA11 Adenomyosis). The development of the guidelines on the diagnosis and treatment of adenomyosis by two organizations at once, the Asian Society of Endometriosis and Adenomyosis and the Society of Obstetricians and Gynaecologists of Canada, in 2023 is an indirect evidence of that. Using dienogest 2 mg as monotherapy or dienogest-based combined oral contraceptives (for patients in need of reliable contraception) is one of the most suitable options for the long-term effective adenomyosis symptom management.
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Abstract

Today, both adenomyosis and endometriosis are at the forefront of scientific debate. The kinship of adenomyosis and endometriosis at first glance still raise no doubts, since there is reliable scientific evidence of the fact that the pathogenesis of these disease entities has much in common. However, despite the continuing similarity, adenomyosis is currently considered as a separate disorder; in the updated International Classification of Diseases 11th Revision adenomyosis is not included in the endometriosis section (GA10 Endometriosis), but allocated to a separate category (GA11 Adenomyosis). The development of the guidelines on the diagnosis and treatment of adenomyosis by two organizations at once, the Asian Society of Endometriosis and Adenomyosis and the Society of Obstetricians and Gynaecologists of Canada, in 2023 is an indirect evidence of that. Using dienogest 2 mg as monotherapy or dienogest-based combined oral contraceptives (for patients in need of reliable contraception) is one of the most suitable options for the long-term effective adenomyosis symptom management.

Keywords

adenomyosis, pathogenesis, drug therapy, dienogest, combined oral contraceptives. For citation:Orazov M.R. Adenomyosis: clinicist’s tactics through the prism of domestic and international guidelines. Clinical review for general practice. 2025; 6 (2): 10–15 (In Russ.). DOI: 10.47407/kr2025.6.2.00564 All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

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endometriosisadenomyosis

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