Clinicopathological characteristics of adenomyosis with and without coexisting leiomyomas and/or endometriosis: a retrospective hysterectomy cohort study

Aims To compare the clinical and pathological characteristics of histologically confirmed adenomyosis with and without coexisting leiomyoma and/or endometriosis in a hysterectomy cohort.

We conducted a retrospective, pathology-based cohort study of hysterectomy specimens obtained at a tertiary center between 2012 and 2017. Among the 2028 hysterectomies performed, 297 patients were diagnosed with histologically confirmed adenomyosis, resulting in a prevalence rate of 14.6%. Patients were classified as having adenomyosis without coexisting leiomyoma or endometriosis, or as having adenomyosis with coexisting leiomyoma and/or endometriosis. Demographics, presenting symptoms, and concurrent gynecologic malignancies were compared between groups. Multivariable logistic regression and additional sensitivity analyses were used to assess factors independently associated with concurrent gynecologic malignancy.

Adenomyosis without coexisting leiomyoma or endometriosis was identified in 119 patients (40.1%), whereas adenomyosis coexisting with leiomyoma and/or endometriosis was identified in 178 patients (59.9%). Patients without coexisting leiomyoma or endometriosis were older than those with coexisting leiomyoma and/or endometriosis (mean 54.2 vs. 50.0 years; p = 0.001). Menorrhagia was less frequent (50 vs. 115 patients; p < 0.001), whereas postmenopausal bleeding (24 vs. 19 patients; p = 0.024) and uterine prolapse (17 vs. 12 patients; p = 0.033) were more frequent in this group. Concurrent gynecologic malignancy was also more frequent in patients without coexisting leiomyoma/endometriosis (n = 42, 35.3% vs. n = 17, 9.6%; p < 0.001). This association remained significant after multivariable adjustment (aOR 5.22, 95% CI 2.66–10.6; p < 0.001) and in age-focused sensitivity analyses. In subtype-specific analyses, the association was primarily observed in endometrial cancer.

In this retrospective hysterectomy cohort, adenomyosis without coexisting leiomyoma/endometriosis and adenomyosis coexisting with leiomyoma and/or endometriosis showed different clinicopathological features. Adenomyosis without coexisting leiomyoma/endometriosis was associated with a higher frequency of concurrent gynecologic malignancy, mainly endometrial cancer. These findings should be interpreted within the limitations of this retrospective, hysterectomy-based design. Abbreviations - CA-125: - Cancer Antigen (CA) 125 - aORs: - Adjusted odds ratios - CIs: - Confidence intervals - COX-2: - Cyclooxygenase-2 Funding The authors received no specific funding for this work. Author information Authors and Affiliations Corresponding author Ethics declarations Ethical approval and consent to participate The study was approved by the Institutional Ethics Committee of Umraniye Training and Research Hospital (approval no. 113, approval date: 02/10/2017). Due to the retrospective design and use of existing records, the requirement for individual informed consent was waived by the ethics committee. No written consent has been obtained from the patients, as no patient-identifiable data are included. The study was conducted in accordance with the Declaration of Helsinki and relevant guidelines and regulations. Conflict of interest The authors declare no conflicts of interest. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Vural, N.A., Yeğin, E.E., Ergin Yılar, B. et al. Clinicopathological characteristics of adenomyosis with and without coexisting leiomyomas and/or endometriosis: a retrospective hysterectomy cohort study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04832-1 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04832-1