Adenomyosis: aspects of pathogenesis and current diagnostic opportunities

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