*7.2.4 Uterine artery embolization (UAE)*

It has been used to relieve symptoms for adenomyosis. UAE has favorable outcomes in symptomatic adenomyosis, both short-term and long-term [25]. Due to the limited clinical data, the side effects on ovarian function and future pregnancy after UAE are still not clear.

**Figure 4.**

*MRI of adenomyosis in (a) showed the diffuse lesion before HIFU, and (b) showed the nonperfused area of the lesion without damage to the surrounding normal tissue after HIFU.*

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*Adenomyosis*

*DOI: http://dx.doi.org/10.5772/intechopen.90942*

with endometriotic implants.

**9. Conclusion**

myosis is a hysterectomy.

**Acknowledgements**

reference in organizing our paper.

**8. Adenomyosis malignant transformation**

As with other pathologies of endometriosis, adenomyosis may goes malignant transformation. It is not clear whether some malignancies being as such or progress from benign disease to malignant. The neoplasia arises coincidentally in continuity

Although adenomyosis is usually benign, it might also be a precursor of malignant disease. As the incidence of adenomyosis malignant transformation is low, and its clinical manifestation is nonspecific, it may only be confirmed by postoperative pathological examination. Malignant neoplasia occurs rarely in the glands and/ or stroma; these tumors may be in the form of adenocarcinomas, sarcomas, or carcinosarcomas. Further investigations with large samples may provide additional data of the prognosis of adenomyosis malignant transformation [26]. Some of the risk factors of malignant adenomyosis include age between 40 and 50 years, early menarche, short menstrual cycle, first delivery at young age, fertility, curettage during early trimester of pregnancy, obesity, and history of tamoxifen intake. The expression of both PR and ER was positive in patients with endometrial carcinoma combined with adenomyosis or endometrial carcinoma combined with uterine fibroids, and the expression of p53 and Ki67 was positive in eutopic malignant endometrium and negative in normal ectopic endometrium, which may provide additional pathological data on adenomyosis malignant transformation [26, 27].

Adenomyosis is a condition in which the inner lining of the uterus (the endometrial) breaks through the uterus myometrium. Adenomyosis can cause menstrual cramps, lower abdominal pain, and heavy periods, and negatively impact on a woman's quality of life. The condition can be located throughout the entire endometrium or localized in one spot. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve mild pain associated with adenomyosis. Symptoms such as heavy or painful periods can be controlled with hormonal therapies. HIFU focused on a small focal region to increase tissue temperature sufficiently, which causes irreparable cell damage in the target adenomyosis lesions at a certain depth. And uterine artery embolization, the minimally invasive procedure, used to block the blood vessels therefore causes adenomyosis shrinks. Endometrial ablation destroys the lining of the uterus and relief from the heavy bleeding. The only definitive cure for adeno-

Thanks to Dr. Courtney Marsh, his book "Endometriosis" is an influential

*Endometriosis*

tomatic adenomyosis.

acceptable if future pregnancy desired.

*7.2.4 Uterine artery embolization (UAE)*

after UAE are still not clear.

*7.2.2 Ablation of adenomyosis using high-intensity focused ultrasound (HIFU)*

*7.2.3 Ablation of endometrium with adenomyosis using MEA or NovaSure*

Endometrial ablation or resection using hysteroscopy has been used to successfully treat dysmenorrhea and menorrhagia caused by adenomyosis. But it is not

It has been used to relieve symptoms for adenomyosis. UAE has favorable outcomes in symptomatic adenomyosis, both short-term and long-term [25]. Due to the limited clinical data, the side effects on ovarian function and future pregnancy

*MRI of adenomyosis in (a) showed the diffuse lesion before HIFU, and (b) showed the nonperfused area of the* 

*lesion without damage to the surrounding normal tissue after HIFU.*

High-intensity focused ultrasound (HIFU) ablation, which was initially developed for the treatment of solid tumors, is now successfully implemented in the treatment of uterine fibroids and adenomyosis [21–23]. Several prospective studies have demonstrated ranges of effectivity between 81 and 87% [21–24]. After HIFU therapy, MRI showed the diffuse adenomyosis in **Figure 4(a)** and the nonperfused area of the lesion without damage to the surrounding normal tissue in **Figure 4(b)**. Rarely serious complications including major permanent injuries were observed. Ultrasound-guided HIFU ablation may be a safe and effective noninvasive alternative in the treatment of symp-

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**Figure 4.**
