OC10.04: The prevalence of sonographic signs of adenomyosis in women undergoing surgery for endometriosis

To determine the prevalence of adenomyosis using transvaginal ultrasound in women undergoing surgery for endometriosis at a large tertiary referral center. Women referred for evaluation at a tertiary referral endometriosis center underwent a transvaginal ultrasound scan with three dimensional capabilities (Voluson 730 Pro system) by a single highly trained operator. Diagnosis of adenomyosis was made when any one of the following criteria was present: asymmetrical myometrial thickening, linear striations, myometrial cysts, hyperechoic islands, irregular endometrial-myometrial junction, parallel shadowing, and localized adenomyomas. A diagnosis of endometriosis which required surgery was made based on clinical criteria and findings at the time of the ultrasound scan. During the study period 103 women underwent surgery, with mean age 34±6.1 (range 20–47), mean parity 0.9±1.2 (0–6), 57 (55.5%) were nulliparous, 9 (8.7%) after Cesarean sections. Symptoms included dysmenorrhea (91.5%), dyspareunia (59.6%), urinary complaints (25.3%), gastrointestinal complaints (50.5%) and infertility (31%). 24 (23.3%) had undergone IVF treatments with 15 undergoing 3 cycles or more (range 1–16). At least one sonographic sign indicative of adenomyosis was observed in ninety one women (88.4%): asymmetrical myometrial thickening (75.6%), linear striations (26.3%), myometrial cysts (85.3%), hyperechoic islands (80%), irregular endometrial-myometrial junction (86.3), parallel shadowing (57.9%), and localized adenomyomas (39%). The presence of sonographic findings was associated with age, dysmenorrhea, dyspareunia, and infertility. Histological confirmation of adenomyosis was unavailable as none of the women underwent a hysterectomy but endometriosis was confirmed in all. Sonographic signs of adenomyosis are highly prevalent in women undergoing surgery for endometriosis.This bears direct implications on tailoring patient specific treatment both before and after the operation, such as secondary prevention or timing of fertility treatments.