AbstractIn 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging
techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmen-orrhea, chronic pelvic pain, and dysfunctional uterine bleed-ing. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treat-ment is increasing. Therefore, in these patients, uterine explo-ration should include not only the evaluation of the endome-trial cavity but also the exploration of the sub-endometrial zone. Indirect imaging techniques, combinedwith officemini-hysteroscopy, offer the possibility of complete uterine explo-ration. Two patients with cystic adenomyosis are described in this paper: one had the chief complaint ofmenorrhagia and the other was referred for evaluation of infertility and severe dysmenorrhea. The aim of these case reports is to present hysteroscopic dissection and ablation of adenomyotic cysts as an alternative procedure for the surgical management of this condition