Detection of Adenomyosis via Hysterosalpingography in Routine Infertility Assessments

Adenomyosis is a medical condition characterized by the presence of endometrial glands within the uterine myometrium. Although approximately one-third of individuals with adenomyosis show no symptoms, the majority may experience heavy menstrual bleeding, pelvic discomfort, or difficulties with fertility. The co-occurrence of adenomyosis with other gynecological conditions, particularly endometriosis, has been widely documented in the literature. This simultaneous presence can intensify clinical symptoms and complicate diagnosis and management. The risk of developing adenomyosis increases with age, number of pregnancies, and a history of uterine surgeries. While it is most commonly diagnosed in women in their 40s and 50s, advancements in imaging technologies have led to a growing number of diagnoses in younger women experiencing infertility. The diagnosis of adenomyosis usually starts with clinical suspicion and is confirmed through pelvic ultrasound or MRI. Given its link to infertility, adenomyosis can also appear as an incidental finding on hysterosalpingography (HSG) in patients undergoing infertility evaluation, even in the absence of specific symptoms. Characteristic features of adenomyosis on hysterosalpingography include mild to moderate enlargement of the uterine cavity and small diverticulum-like outpouchings resulting from the penetration of contrast material into the myometrium, which can be localized or diffuse. This observational review study aims to explore the imaging characteristics of adenomyosis and its associated comorbid conditions as seen on hysterosalpingography. Although the diagnosis of adenomyosis on hysterosalpingography is not definitive, it is clinically valuable, particularly in infertile women, as it impacts patient counseling, guides treatment strategy, improves the prognosis of assisted reproductive techniques, and prompts confirmation via more sensitive methods.