{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:20:05Z","timestamp":1789802405441,"version":"4.0.1"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Adenomyosis is an estrogen\u2010dependent disorder characterized by substantial heterogeneity in lesion distribution, symptom presentation, disease severity, and reproductive impact, which limits the effectiveness of uniform treatment strategies. To summarize recent evidence on pharmacological and minimally invasive treatments for adenomyosis and to propose a clinically practical framework for treatment selection based on magnetic resonance imaging (MRI)\u2010based lesion subtypes, symptom phenotypes, disease severity, and reproductive intentions. A narrative review of recent literature was conducted focusing on hormonal therapies, gonadotropin\u2010releasing hormone (GnRH) antagonists, the levonorgestrel\u2010releasing intrauterine system (LNG\u2010IUS), dienogest, and minimally invasive treatments such as high\u2010intensity focused ultrasound (HIFU) and endometrial ablation. Outcomes were evaluated in relation to MRI\u2010based lesion localization, predominant symptoms, uterine size, and fertility preservation goals. Pharmacological therapy remains the cornerstone of conservative management. Sequential strategies using short\u2010term GnRH antagonists followed by maintenance therapy have been explored, although robust evidence is limited. LNG\u2010IUS and dienogest are commonly selected according to bleeding\u2010 or pain\u2010dominant symptoms and MRI\u2010based lesion subtypes, but interindividual variability in treatment response persists. Minimally invasive treatments show favorable outcomes mainly in localized disease, whereas efficacy in diffuse adenomyosis remains inconsistent. Treatment strategies differ according to reproductive intentions, with time\u2010limited interventions being central in fertility\u2010preserving management. Treatment of adenomyosis should move beyond a uniform approach toward individualized strategies integrating imaging findings and patient characteristics. An MRI\u2010based framework may support more rational and effective clinical decision making.<\/jats:p>","DOI":"10.1002\/ijgo.70992","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:29:53Z","timestamp":1774610993000},"page":"1288-1296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment selection for adenomyosis based on imaging findings and patient characteristics"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8124-6269","authenticated-orcid":false,"given":"Hiroshi","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Nara Medical University  Kashihara Japan"},{"name":"Department of Gynecology and Reproductive Medicine Ms.Clinic MayOne  Kashihara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cimb47050298"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14904"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-017-0576-z"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1387515"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.125700.2"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deae105"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000505690"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000535802"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10214878"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14196956"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom14060616"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-023-01957-7"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2015.05.015"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13600"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-29227-2"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.769187"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1719016"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/17425255.2024.2441981"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2021.09.019"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1278"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2025.04.037"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-025-03681-8"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10245794"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13113302"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13175224"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.04.017"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-024-07546-7"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-015-3755-5"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2014.926882"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1159\/000529185"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2024.102795"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2025.2511329"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2025.104880"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2019.1683818"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14650"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-54096-z"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-93156-5"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2023.08.003"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14612"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12887"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43032-022-01077-9"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/26334941241227401"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.96235"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12958-025-01349-4"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.97669"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2022.08.006"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2025.11.019"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13226844"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441783"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2017.12.020"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13195828"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2024.2372645"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-37096-y"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2024.01.036"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.13720"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1080\/02656736.2019.1595179"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2025.114737"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.28943"},{"key":"e_1_2_12_60_1","unstructured":"2021 exceptional surveillance of heavy menstrual bleeding: assessment and management (NICE guideline NG88).National Institute for Health and Care Excellence (NICE).2021.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK571008\/"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2023.04.008"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70992","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.70992","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70992","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:32:33Z","timestamp":1789799553000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70992"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":60,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ijgo.70992"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70992","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"2026-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}