Reviewed by: Dr. Priyadatt Patel, Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead. Last updated: 26 May 2026.
Endometriosis · Adenomyosis & DIE
Adenomyosis and Deep Infiltrating Endometriosis
Adenomyosis (endometrial tissue within the uterine muscle) and deep infiltrating endometriosis (DIE) represent the more severe end of the endometriosis spectrum. Diagnosis requires specific protocols; management is more complex.
Adenomyosis
Disease in the uterine wall
Endometrial glands and stroma within the myometrium. Causes heavy menstrual bleeding, dysmenorrhoea, dyspareunia, and infertility. Diagnosis by ultrasound (MUSA criteria) or MRI. Often coexists with endometriosis.
Deep infiltrating endometriosis
Beyond surface lesions
Disease penetrating more than 5mm beneath peritoneal surface. Common sites: uterosacral ligaments, recto-vaginal septum, bowel, bladder, ureters. Requires specialised mapping (#Enzian system) and often multidisciplinary surgical input.
Management approach
Individualised and multidisciplinary
Medical management often first-line. Surgery for symptomatic patients not responsive to medical therapy. For DIE: requires meticulous specialised surgery sometimes with colorectal or urology input. For adenomyosis: uterine-sparing options vs hysterectomy depending on fertility goals.
Common questions
Frequently asked
Can adenomyosis be cured without hysterectomy?
Conservative options exist (hormonal management, GnRH agonists, focused ultrasound, partial adenomyomectomy) but recurrence rates limit durability. Hysterectomy is definitive for women not desiring fertility.
Is deep infiltrating endometriosis dangerous?
It can cause severe symptoms, organ dysfunction, and complications if untreated. Bowel involvement can cause obstruction; ureteric involvement can damage kidneys. Specialist evaluation matters.
Will I need bowel surgery for DIE?
Only if disease is significantly infiltrating bowel. Conservative shaving for mild involvement; partial bowel resection for deeper invasion. Multidisciplinary planning with colorectal surgery as needed.
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Dr. Priyadatt Patel
Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead
MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation
ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.
Endometriosis
Superficial to deep infiltrating, fertility-preserving excision
IVF & Fertility
Individualised protocols, ART Level 2 lab, transparent outcomes
Advanced Laparoscopy
3D Karl Storz precision, nerve-sparing technique
Pregnancy Care
Antenatal care, high-risk pregnancy, advanced ultrasound
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