Improved surgical outcomes in adenomyosis: a novel insight into the superiority of secretory phase adenomyomectomy.

OBJECTIVE

To evaluate whether the timing of adenomyomectomy within the menstrual cycle influences outcomes in patients with adenomyosis, and to assess whether surgery performed during the secretory phase offers clinical advantages over the proliferative phase.

METHODS

We conducted a retrospective cohort study of patients with histologically confirmed adenomyosis who underwent uterus-sparing adenomyomectomy at our institution between January 2021 and April 2024. Patients were categorized according to the menstrual phase at the time of surgery: secretory phase and proliferative phase. The primary outcomes were postoperative recurrence rate and time to recurrence. Comparative analysis was conducted between the two groups.

RESULTS

Of 163 patients initially enrolled, 143 were included in the final analysis after excluding 20 lost to follow-up (secretory phase: n = 80; proliferative phase: n = 63). The secretory phase group exhibited a significantly lower recurrence rate (14.3% vs. 38.8%, P < 0.001) and a longer median recurrence-free survival [median RFS: 45.19 (41.69-48.70) vs. 34.40 (29.89-38.91) months, log-rank P = 0.001], as demonstrated by Kaplan-Meier analysis. No significant differences were observed in intraoperative blood loss or postoperative complication rates. In multivariate Cox regression analysis, surgery during the secretory phase remained an independent protective factor against recurrence. Compared to the proliferative phase, surgery in the secretory phase was associated with a significantly reduced risk of recurrence (HR = 0.277, 95% CI 0.114-0.673, P = 0.005), corresponding to a 72.3% risk reduction after adjusting for potential confounders.

CONCLUSION

Adenomyomectomy performed during the secretory phase is associated with significantly lower recurrence rates and improved long-term outcomes. These findings provide novel evidence supporting the secretory phase as a potentially optimal surgical window for the treatment of adenomyosis, which may contribute to optimizing surgical timing in clinical practice.