Adenomyosis: aspects of pathogenesis and current diagnostic opportunities

A.I. Ishchenko, M.A. Shchetkina, N.S. Zemlina, E.V. Minashkina, T.A. Dzhibladze, E.A. Svidinskaya, M.B. Ageev, D.V. Bryunin, G.F. Proklova, N.I. Borisova
In: Voprosy ginekologii, akušerstva i perinatologii · 2025 · vol. 24(4) , pp. 96–104 · doi:10.20953/1726-1678-2025-4-96-104 · W7125526882
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⚙ AI-generated summary by claude@2026-07, 2026-07-16 ⓘ

This review analyzes recent literature on adenomyosis, highlighting the effectiveness of 2D and 3D ultrasounds with MUSA criteria for diagnosis and promising new methods like elastography and MRI.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-16 · read from full text ⓘ

This narrative paper reviews recent literature on adenomyosis, focusing on proposed aspects of its pathogenesis and on diagnostic options, noting that incidence has increased in recent years with more cases reported in young women. It summarizes that adenomyosis is associated in many studies with reduced pregnancy chance, increased risk of early pregnancy loss, stillbirth, and failure of assisted reproductive technology, while also emphasizing that the disease pathogenesis is not fully understood and several complementary hypotheses exist. For diagnosis, it describes ultrasound as the “gold standard” and explains that Morphological Uterus Sonographic Assessment (MUSA) criteria using direct and indirect 2D/3D ultrasound signs improve diagnostic accuracy and help standardize management; it also highlights promising approaches including intraoperative navigation with elastography and combinations of 3D ultrasound and MRI to localize myometrial foci. This paper is centrally about adenomyosis—specifically reviewing pathogenesis hypotheses and diagnostic opportunities using 2D/3D ultrasound with MUSA criteria.

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Abstract

In recent years, the incidence of adenomyosis has increased significantly, with more cases being reported in young women. The pathogenesis of this disease is not fully understood, and there are many complementary hypotheses. According to most studies, adenomyosis reduces the chance of pregnancy, increases the risk of early pregnancy loss, stillbirth, and failure in assisted reproductive technology (ART) programs. Ultrasound is considered the “gold standard” for diagnosing adenomyosis. The Morphological Uterus Sonographic Assessment (MUSA) criteria, based on direct and indirect signs of adenomyosis detected by 2D and 3D ultrasounds and their combination, improve the accuracy of diagnosis and allow standardizing the management of patients. Objective. To analyze recent literature on the pathogenesis and diagnosis of adenomyosis. Conclusion. 2D and 3D ultrasounds guided by MUSA criteria are effective in the diagnosis of adenomyosis. Intraoperative navigation with elastography, a combination of 3D ultrasound and MRI for accurate diagnosis of adenomyosis foci in the myometrium, and gentle surgical treatment are promising methods. Key words: adenomyosis, infertility, hysteroscopy, ultrasound diagnosis, elastography, MUSA criteria, 3D ultrasound, transition zone
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Adenomyosis: aspects of pathogenesis and current diagnostic opportunities Anatoliy I. Ishchenko / Maria A. Shchetkina / Natalya S. Zemlina / Elena V. Minashkina / Thea A. Dzhibladze / Evgenya A. Svidinskaya / Mikhail B. Ageev / Dmitriy V. Bryunin / Guzel F. Proklova / Nataliya I. Borisova / In recent years, the incidence of adenomyosis has increased significantly, with more cases being reported in young women. The pathogenesis of this disease is not fully understood, and there are many complementary hypotheses. According to most studies, adenomyosis reduces the chance of pregnancy, increases the risk of early pregnancy loss, stillbirth, and failure in assisted reproductive technology (ART) programs. Ultrasound is considered the “gold standard” for diagnosing adenomyosis. The Morphological Uterus Sonographic Assessment (MUSA) criteria, based on direct and indirect signs of adenomyosis detected by 2D and 3D ultrasounds and their combination, improve the accuracy of diagnosis and allow standardizing the management of patients. Objective. To analyze recent literature on the pathogenesis and diagnosis of adenomyosis. Conclusion. 2D and 3D ultrasounds guided by MUSA criteria are effective in the diagnosis of adenomyosis. Intraoperative navigation with elastography, a combination of 3D ultrasound and MRI for accurate diagnosis of adenomyosis foci in the myometrium, and gentle surgical treatment are promising methods. Key words: adenomyosis, infertility, hysteroscopy, ultrasound diagnosis, elastography, MUSA criteria, 3D ultrasound, transition zone For citation: Ishchenko A.I., Shchetkina M.A., Zemlina N.S., Minashkina E.V., Dzhibladze T.A., Svidinskaya E.A., Ageev M.B., Bryunin D.V., Proklova G.F., Borisova N.I. Adenomyosis: aspects of pathogenesis and current diagnostic opportunities. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2025; 24(4): 96–104. (In Russian). DOI: 10.20953/1726-1678-2025-4-96-104

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