To evaluate changes in quality of life, menstrual symptoms, hematologic status, and sexual function in women with severe diffuse adenomyosis treated with uterine-sparing adenomyomectomy followed by structured postoperative medical therapy.

This prospective study included 62 women with grade III–IV diffuse adenomyosis who underwent extended uterine-sparing adenomyomectomy using the Osada procedure. Postoperative therapy consisted of gonadotropin-releasing hormone (GnRH) agonists for six months, followed by progestins or dydrogesterone for another six months. Adjunct supplementation with Indole-3-carbinol and Epigallocatechin-3-gallate was provided for six months as an exploratory measure. Quality of life was assessed at baseline, 12 months, and 24 months using the SF-36 and EHP-30 questionnaires; sexual function was evaluated using the Female Sexual Function Index (FSFI). Baseline menstrual and hematologic parameters were compared with a control group of 30 women with tubal-factor infertility.

Menstrual duration decreased significantly (median 10 → 4.6 days), PBAC scores improved (130 → 16; p < 0.05), and hemoglobin levels normalized in 90% of patients by 12 months. Significant improvements were observed across all SF-36 domains, especially physical functioning, vitality, and bodily pain. EHP-30 scores showed substantial reductions in pain and emotional distress. FSFI scores improved across all domains, with a notable decrease in dyspareunia and stabilization by 12 months. The mean operative time was 157 min, and estimated blood loss averaged 512 mL.

This combined surgical–medical treatment approach resulted in significant and sustained improvements in symptoms, hematologic status, sexual function, and overall quality of life. As all patients received prolonged hormonal therapy, the specific contribution of surgery alone cannot be isolated.