Myometrial disease extent on standardized morphological uterus sonographic assessment transvaginal ultrasound is associated with severe dysmenorrhea in women with adenomyosis: a prospective observational study

Aim was to evaluate associations between standardized morphological uterus sonographic assessment (MUSA) transvaginal ultrasound features and dysmenorrhea severity in women with adenomyosis.

This prospective observational study included 42 consecutive premenopausal women with secondary dysmenorrhea and sonographically diagnosed adenomyosis between March 2025 and March 2026. Standardized transvaginal ultrasound was performed using a GE Voluson E8 system with an 8-MHz transvaginal transducer. MUSA features, disease type, and myometrial disease extent were recorded. Dysmenorrhea was assessed using a 0-10 numerical rating scale. Group comparisons and diagnostic performance measures were evaluated.

Participants had mild (n=16), moderate (n=10), or severe (n=16) dysmenorrhea. Heavy menstrual bleeding, dyspareunia, chronic pelvic pain, several direct MUSA features, and the presence of at least two direct MUSA features increased across symptom groups. Myometrial involvement >50% occurred in 56.3% of women with severe dysmenorrhea versus 6.3% with mild symptoms. For severe dysmenorrhea, disease extent >50% had 56.3% sensitivity, 88.5% specificity, 75.0% positive predictive value, 76.7% negative predictive value, and 76.2% accuracy.

Greater myometrial disease extent was strongly associated with dysmenorrhea severity in this cohort. Standardized reporting of disease extent may add clinically useful information to MUSA-based ultrasound assessment, but larger patient-level studies are required to determine independent predictive value. Metrics

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