Hysteroscopic Pattern Characterization in Adenomyosis Diagnosed by MUSA 2022 Criteria: A Prospective Observational Study

Berivan Guzelbag, Bahat PY, Pinar Yalcin Bahat, Pınar Yalçın Bahat
Journal of Obstetrics and Gynaecology Research · 2026 · vol. 52(5) , pp. e70329 · doi:10.1111/jog.70329 · PMID:42134905 · W7161122811
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⚙ AI-generated summary by claude@2026-07, 2026-07-17 ⓘ

This prospective study characterized hysteroscopic findings in 40 women with MUSA-diagnosed adenomyosis, revealing predominant hemorrhagic, vascular, and structural abnormalities occurring concurrently in most cases.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-17 · read from full text ⓘ

This prospective observational study evaluated 40 symptomatic women aged 18–55 years with ultrasonographically confirmed adenomyosis meeting MUSA 2022 criteria, using standardized office hysteroscopy recorded with high-definition video for systematic postprocedural analysis. Endometrial hysteroscopic findings were categorized into structural changes, vascular abnormalities, hemorrhagic manifestations, and endometriotic-like features. Hemorrhagic manifestations were found in all participants (hemorrhagic spots in 97.5%), vascular abnormalities in 97.5% (including hypervascularization patterns), structural abnormalities in 92.5%, and endometriotic-like features in 67.5%, with multiple categories co-occurring in 87.5% of cases; the study explicitly notes it is observational and does not establish diagnostic performance. This paper is centrally about endometriosis/adenomyosis — it specifically characterizes hysteroscopic pattern frequencies in adenomyosis diagnosed by MUSA 2022 criteria.

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Abstract

OBJECTIVE: Despite growing recognition of adenomyosis as a significant gynecological condition, standardized hysteroscopic diagnostic criteria remain lacking. This study aimed to systematically characterize endometrial hysteroscopic findings in ultrasonographically confirmed adenomyosis using a clinically relevant classification framework and determine their frequency and morphological patterns in symptomatic women. STUDY DESIGN: Prospective study of 40 women (18-55 years) with MUSA-confirmed adenomyosis who underwent standardized office hysteroscopy at a tertiary center (August 2022-May 2023). All procedures were video-recorded using high-definition equipment for systematic postprocedural analysis. Endometrial findings were systematically categorized into four clinically relevant domains: structural changes, vascular abnormalities, hemorrhagic manifestations, and endometriotic-like features. RESULTS: Hemorrhagic manifestations were present in all 40 patients in our cohort, with hemorrhagic spots identified in 97.5% of cases. Vascular abnormalities occurred in 97.5% of patients: hypervascularization (35.0%), marked hypervascularization (37.5%), focal hyperemia (65.0%), and diffuse hyperemia (25.0%). Structural abnormalities were identified in 92.5% of cases: irregular endometrium (37.5%), trabeculations with small surface openings (25.0%), and enlarged tubal orifices (30.0%). Endometriotic-like features were present in 67.5% of patients: strawberry pattern appearance (25.0%) and white spot lesions (42.5%). Chocolate-brown hemorrhagic lesions occurred in 17.5% of cases. Multiple morphological categories were present concurrently in 87.5% of patients. CONCLUSION: Patients with ultrasonographically confirmed adenomyosis demonstrate characteristic hysteroscopic patterns with predominantly multiple concurrent morphological abnormalities. This systematic characterization provides a standardized framework for hysteroscopic assessment and establishes the foundation for potential integration with existing imaging-based diagnostic approaches.
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Abstract

Objective Despite growing recognition of adenomyosis as a significant gynecological condition, standardized hysteroscopic diagnostic criteria remain lacking. This study aimed to systematically characterize endometrial hysteroscopic findings in ultrasonographically confirmed adenomyosis using a clinically relevant classification framework and determine their frequency and morphological patterns in symptomatic women. Study Design Prospective study of 40 women (18–55 years) with MUSA-confirmed adenomyosis who underwent standardized office hysteroscopy at a tertiary center (August 2022–May 2023). All procedures were video-recorded using high-definition equipment for systematic postprocedural analysis. Endometrial findings were systematically categorized into four clinically relevant domains: structural changes, vascular abnormalities, hemorrhagic manifestations, and endometriotic-like features.

Results

Hemorrhagic manifestations were present in all 40 patients in our cohort, with hemorrhagic spots identified in 97.5% of cases. Vascular abnormalities occurred in 97.5% of patients: hypervascularization (35.0%), marked hypervascularization (37.5%), focal hyperemia (65.0%), and diffuse hyperemia (25.0%). Structural abnormalities were identified in 92.5% of cases: irregular endometrium (37.5%), trabeculations with small surface openings (25.0%), and enlarged tubal orifices (30.0%). Endometriotic-like features were present in 67.5% of patients: strawberry pattern appearance (25.0%) and white spot lesions (42.5%). Chocolate-brown hemorrhagic lesions occurred in 17.5% of cases. Multiple morphological categories were present concurrently in 87.5% of patients.

Conclusion

Patients with ultrasonographically confirmed adenomyosis demonstrate characteristic hysteroscopic patterns with predominantly multiple concurrent morphological abnormalities. This systematic characterization provides a standardized framework for hysteroscopic assessment and establishes the foundation for potential integration with existing imaging-based diagnostic approaches. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The datasets generated and analyzed during the current study include individual-level clinical and hysteroscopic imaging data from patients with ultrasonographically confirmed adenomyosis. Due to the sensitive nature of these data and the restrictions imposed by the Institutional Review Board approval, public data sharing is not permitted. Deidentified data may be made available from the corresponding author upon reasonable request, subject to additional ethical approval.

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Outcome instruments

MUSA

Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (30)

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