{"paper_id":"8b3b2a82-0080-4e27-b03e-d0c1cbac1d4e","body_text":"Abstract\nBackground\nTo evaluate whether the intensity of pain symptoms in women with adenomyosis and endometriosis is associated with the specific lesion localizations or with disease extension.\nMethods\nA retrospective investigation was performed on 234 women with sonographic diagnosis of adenomyosis and endometriosis (cases), of whom 174 (74.4%) had adenomyosis, 89 (38.0%) superficial endometriosis, 103 (44.0%) ovarian endometriosis, and 131 (56.0%) deep infiltrating endometriosis (DIE) of the utero-sacral ligaments (USL; n = 76), rectum (n = 61), parametrium (n = 46), and vesical-uterine folder (n = 13); 75 control women were also enrolled. Menstrual and intermenstrual pain, deep dyspareunia, dysuria, dyschezia, and low back pain were rated on a visual analogue scale (VAS). The modification of each symptom with therapy was evaluated in the 123 women receiving progestin-only (P; n = 81) or estro-progestin (EP; n = 42) treatment, also comparing P versus EP.\nResults\nConcomitant lesions were more frequent (78.6%) than single localizations (21.4%). Superficial endometriosis was independently associated with more intense menstrual pain (median difference 2.62, 95% CI 1.10–4.15), deep dyspareunia (median difference 1.91, 95%CI 0.09–3.74), and low back pain (median difference 2.03, 95%CI 0.06–3.99), and with higher odds of dyschezia (OR 2.44, 95%CI 1.01–5.89). Ovarian endometriosis was associated with more intense menstrual pain (median difference1.93, 95%CI 0.63–3.24) but with less intense intermenstrual pain (median difference − 2.30, 95%CI -3.89 to -0.71) and deep dyspareunia (median difference − 3.17, 95%CI -4.97 to -1.38). DIE of the USL was associated with lower odds of dyschezia (OR 0.36, 95%CI 0.14–0.92), whereas adenomyosis and DIE of the rectum or parametrium were not independently associated with any pain symptom. The response to therapy did not differ among localizations for most symptoms: women with ovarian endometriosis had higher odds of a smaller-than-average reduction of intermenstrual pain (OR 3.04, 95%CI 1.12–8.26), and women with DIE of the parametrium of deep dyspareunia (OR 5.31, 95%CI 1.02–27.60). A poorer response of deep dyspareunia was observed in women receiving P than EP (OR 4.03, 95%CI 1.49–10.92). At baseline all symptoms were more intense in cases than in controls except dysuria; at follow-up they remained higher except for menstrual pain and dysuria.\nConclusions\nThe intensity of pain and its response to hormonal therapy were associated with the specific lesion localizations, rather than with the number of concomitant lesions. Superficial endometriosis appears to be the localization associated with more intense pain symptoms.\nSimilar content being viewed by others\nAbbreviations\n- BMI:\n-\nBody mass index\n- CER:\n-\nRegional Ethics Committee\n- CI:\n-\nConfidence interval\n- CR:\n-\nCoefficient of regression\n- DIE:\n-\nDeep infiltrating endometriosis\n- EP:\n-\nEstro-progestins\n- IDEA:\n-\nInternational Deep Endometriosis Analysis\n- MUSA:\n-\nMorphological Uterus Sonographic Assessment\n- P:\n-\nProgestins\n- SD:\n-\nStandard deviation\n- USL:\n-\nUtero sacral ligaments\n- VAS:\n-\nVisual analogue scale\nAcknowledgements\nWe would like to thank all the sanitary personnel for their help in patient management.\nFunding\nThis study received no funding.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthics approval and consent to participate\nThe study was approved by the local ethics committee. Studies performed in our hospital are approved by the ethics committee of the Regione Liguria. The study was approved with the number CER Liguria 305/2022-DB id 12401). All procedures were performed according to the guidelines of good clinical practice as specified in the Declaration of Helsinki.\nAt enrolment, each woman signed an informed consent to participate in the study.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.\nAbout this article\nCite this article\nXholli, A., Costantino, A., Primizia, E. et al. Association of adenomyosis and different endometriosis localizations to pain symptoms and their response to hormone therapy. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04967-1\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04967-1","source_license":"CC0","license_restricted":false}