From the Guidelines
The diagnostic criteria for adenomyosis involve a combination of clinical symptoms, physical examination, and imaging studies, with transvaginal ultrasound (TVUS) being the most sensitive method, having a pooled sensitivity and specificity of 82.5% and 84.6%, respectively, as reported in a meta-analysis of 14 studies 1. The diagnostic approach to adenomyosis typically involves:
- Clinical assessment: evaluating symptoms such as heavy menstrual bleeding, dysmenorrhea, and pelvic pain
- Physical examination: checking for an enlarged, tender uterus
- Transvaginal ultrasound: looking for characteristic signs like heterogeneous myometrium, myometrial cysts, or asymmetrical myometrial thickening, which can be detected with a high degree of sensitivity and specificity, as shown in a study with a sensitivity of 82.5% and specificity of 84.6% 1
- Magnetic Resonance Imaging (MRI): may be used if TVUS is inconclusive, to provide more detailed images of uterine tissue
- Hysteroscopy or endometrial biopsy: may be used to rule out other conditions but cannot definitively diagnose adenomyosis It is essential to note that the detection of adenomyosis at TVUS may be limited if there is coexisting uterine pathology, such as leiomyomas, with a sensitivity and specificity of 33.3% and 78% in patients with leiomyomas, compared to 97.8% and 97.1% in those without leiomyomas 1. Therefore, a combination of clinical suspicion and imaging findings, particularly TVUS, is usually sufficient for a presumptive diagnosis and to guide treatment decisions for adenomyosis 1.
From the Research
Diagnostic Criteria for Adenomyosis
The diagnostic criteria for adenomyosis are not universally agreed upon, and the condition is often underdiagnosed 2, 3, 4. The diagnosis of adenomyosis can be made through a combination of clinical signs and symptoms, imaging techniques, and histopathological examination.
Clinical Signs and Symptoms
The clinical signs and symptoms of adenomyosis can vary widely, but common presentations include:
- Heavy menstrual bleeding
- Dysmenorrhea
- Pelvic pain
- Infertility
- Abnormal uterine bleeding (AUB) 2, 3, 4, 5
Imaging Techniques
Imaging techniques, such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), can be used to help diagnose adenomyosis. The most common findings on 2-dimensional/3-dimensional TVUS and MRI include:
- Enlargement of the uterus
- Heterogeneous myometrial texture
- Cystic areas within the myometrium
- Junctional zone thickening 2, 3, 5, 6
Histopathological Examination
Histopathological examination is considered the "gold standard" for diagnosing adenomyosis 4. The diagnosis is made by identifying endometrial glands and stroma within the myometrium. However, the diagnosis can be challenging, especially in cases with limited disease, and inter-observer reproducibility can be poor 2.
Diagnostic Challenges
The diagnosis of adenomyosis can be challenging due to: