Adenomyosis and fertility: from pathophysiology to optimizing reproductive outcomes

Nihita Manem, Kristen Hori, Lusine Aghajanova
In: Current Opinion in Obstetrics & Gynecology · 2026 · doi:10.1097/gco.0000000000001117 · PMID:42244463 · W7163706079
article OA: closed CC0
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review synthesizes current knowledge on adenomyosis, detailing its pathophysiology, diagnostic features, and evolving fertility treatments including hormonal therapies and surgical interventions, to improve reproductive outcomes.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

PURPOSE OF REVIEW: Adenomyosis is increasingly diagnosed in reproductive-aged patients, particularly those undergoing assisted reproductive technology, due to advances in imaging and standardized diagnostic criteria. Its association with infertility and adverse obstetric outcomes has prompted growing interest in understanding disease mechanisms, prognostic features, and optimal fertility-focused management strategies. This review summarizes recent evidence on the pathophysiology, diagnosis, and treatment of adenomyosis in the context of reproductive outcomes. RECENT FINDINGS: Emerging data highlight multifactorial mechanisms linking adenomyosis to impaired implantation and placentation, including hyperestrogenism, progesterone resistance, junctional zone disruption, immune dysregulation, and chronic inflammation. Studies evaluating imaging features suggest that disease phenotype, lesion size, uterine volume, and junctional zone involvement may influence reproductive outcomes, though findings remain inconsistent. Treatment strategies are evolving, with gonadotropin-releasing hormone agonists, levonorgestrel intrauterine systems, and aromatase inhibitors widely used, and growing evidence supporting pretreatment with prolonged gonadotropin-releasing hormone agonists. Adjunct approaches targeting inflammation, uterine contractility, and hormonal pathways are under investigation. Fertility-preserving procedures, including high-intensity focused ultrasound and adenomyomectomy, show promising but heterogeneous reproductive results. SUMMARY: Adenomyosis remains a clinically heterogeneous condition requiring individualized fertility management. Standardized diagnostic frameworks and well designed prospective studies are needed to clarify prognostic factors and optimize therapeutic strategies to improve reproductive outcomes.

My notes (saved in your browser only)

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (71)

Source provenance

openalex
last seen: 2026-06-07T00:00:05.889243+00:00
License: CC0 · commercial use OK