Adenomyosis. What has changed since the advent of ICD-11?

Abstract

Over the years, it has been discussed that adenomyosis is not merely endometriosis of the uterus, but an independent disease with its inherent pathogenesis and clinical mechanisms. Adenomyosis and endometriosis are distinguished not only by pathogenesis, but also by features of histopathology. In the updated International Classification of Diseases, 11th revision (ICD-11), adenomyosis is not included in the section of endometriosis (GA10 Endometriosis), but is listed under a separate heading (GA11 Adenomyosis). In the description of adenomyosis, its former synonym, endometriosis of the uterus, is no longer present. This calls the need to rethink approaches to the diagnosis and treatment of adenomyosis. “Rejuvenation” of adenomyosis requires innovative treatment methods for such patients. When the conditions are met, intrauterine endosurgery in combination with postoperative hormonal therapy makes it possible to create the most favorable conditions for subsequent conception. If it is impossible to use an intrauterine device with levonorgestrel as hormonal therapy, preference should be given to the 4th generation progestogen – dienogest. When taken daily, dienogest is no less effective than gonadotropin-releasing hormone agonists, but has fewer restrictions on the duration of the course of therapy and has acceptable safety, tolerability, and a lower frequency of hot flashes. Key words: adenomyosis, histogenesis, dienogest, treatment, pathogenesis, endometriosis