The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes

Abstract

The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes Christina K. Rasmussena,*, Estrid S. Hansenb, Sham Al-Mashadi Dahla, Erik Ernstc, Margit Dueholma a Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark b Department of Pathology, Aarhus University Hospital, Aarhus, Denmark c Department of Obstetrics & Gynecology, Horsens Regional Hospital, Horsens, Denmark A R T I C L E I N F O Article history: Received 9 October 2018 Received in revised form 20 March 2019 Accepted 14 April 2019 Available online 30 April 2019 Keywords: Adenomyosis Health-related quality of life Heavy menstrual bleeding Pelvic pain A B S T R A C T Objectives: To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone. Study design: This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n = 112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis of the inner myometrium (intrinsic adenomyosis):

2 mm myometrial invasion without contact to the basal endometrium, serrated junctional zone: > 3 mm myometrial invasion with contact to the basal endometrium and linear junctional zone: No or marginal myometrial invasion ( 3 mm) with contact to the basal endometrium. All study participants received a baseline and two follow- up questionnaires (6 and 18 months after surgery) regarding symptom severity, health-related quality of life and pelvic pain. Data regarding reintervention surgery was obtained from the National Database Patoweb. The rate of reintervention surgery and the improvement in symptom severity, health-related quality of life and pelvic pain were correlated to histopathological findings. Results: Twenty-four patients had intrinsic adenomyosis, 31 had serrated junctional zone and 57 had linear junctional zone. Fifteen patients (13%) underwent reintervention surgery; three (20%) within 6 months, nine (60%) between 6–18 months and three (20%) > 18 months after transcervical endometrial resection. Reintervention surgery was more common in women with intrinsic adenomyosis compared to women without (33% (95% CI: 16–55) vs 8% (95% CI: 3–16)) (p-value: < .05). Nine patients (38%) with intrinsic adenomyosis were asymptomatic based on low symptom severity score, high health-related quality of life and no pelvic pain at 18 months follow-up. Patients with linear junctional zone had a higher improvement in symptom severity and health-related quality of life than patients with intrinsic adenomyosis or serrated junctional zone at 6 months follow-up after surgery (p-value < .05). However, there was no significant difference in pelvic pain reduction. Conclusion: The effect of transcervical endometrial resection may depend upon the degree of junctional zone changes, and patients with intrinsic adenomyosis are more likely to undergo reintervention surgery than patients with either linear or serrated junctional zone. However, intrinsic adenomyosis may also be successfully treated with endometrial resection.