Hysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review

The presence of endometrial glands and stroma within the myometrial wall histologically characterizes adenomyosis, a complicated and multivariate uterine condition. Adenomyosis, which was formerly believed to largely affect multiparous women in their 40s and 50s, is now more widely recognized in younger patients, especially those who have infertility or recurrent pregnancy loss. While there are many different clinical signs, the most common ones are menorrhagia, dysmenorrhea, persistent pelvic pain and most importantly impaired fertility. The development of imaging technologies like MRI and transvaginal ultrasound has made early diagnosis more practical, enabling treatment planning that preserves fertility and earlier intervention. In the past, hysterectomy represented as gold standard regarding final treatment of adenomyosis. However, this surgical treatment prohibits women to become pregnant in the near future. Due to this restriction, focus has shifted to less invasive, uterus-sparing procedures. Of these, hysteroscopic methods most notably, end myometrial excision and localized lesion ablation have attracted a lot of interest. Restoring the uterine cavity's structure and function, reducing discomfort, and above all improving fertility and pregnancy outcomes are the goals of these surgical confrontations. With an emphasis on fertility and obstetric outcomes, this thorough narrative review assesses the available data on hysteroscopic therapy of adenomyosis. Using the terms adenomyosis, hysteroscopy, pregnancy, infertility, treatment and outcomes, a comprehensive search of English-language literature from 2000 to 2025 was carried out, incorporating clinical trials, cohort studies, and systematic reviews from PubMed, Scopus, and Google Scholar. Excluded were studies with no particular reproductive outcome data or that focused on other surgical modalities (laparoscopy, hysterectomy).