Nuances of diagnosis and management of patients with asymptomatic adenomyosis

BACKGROUND: Asymptomatic adenomyosis, which occurs in approximately one-third of patients, is a clinical and scientific enigma, thus being a subject of debate. Practicing physicians face unresolved questions: should they take no action or should they actively monitor and prescribe preventive therapy, especially in the context of preconception care? AIM: The aim of this study was to assess the psychoemotional status, hormonal profile (including oxytocin levels), ultrasound characteristics, and endometrial morphofunctional status in patients with symptomatic or asymptomatic adenomyosis.

This prospective, observational, single-center cohort study was conducted at Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. A total of 641 patients were examined, including 574 women with adenomyosis in the main group and 67 women without gynecological diseases in the comparison group. The diagnosis of adenomyosis was established based on magnetic resonance imaging or ultrasound using a patented method. The patients underwent an assessment of their psychoemotional status using the Quality of Life Questionnaire (SF-36), determination of serum follicle-stimulating hormone, luteinizing hormone, and estradiol levels, as well as plasma oxytocin levels on days 2–6 of the menstrual cycle, and serum progesterone levels on days 19–23 of the menstrual cycle. Histological evaluation of endometrial samples was performed using standard methods on days 7–13 or 16–23 of the menstrual cycle.

Of the 574 patients with adenomyosis in the main group, 530 women presented complaints (abnormal uterine bleeding, pain syndrome), 44 (7.6%) women being asymptomatic. The comparison group comprised 67 women without gynecological diseases. The age of the examined patients ranged from 20 to 48 years, with an average of 36 (7) years. In patients with adenomyosis, an increase in the transitional zone thickness was found in both subgroups, regardless of complaints. In patients with asymptomatic adenomyosis, the average transitional zone thickness was 2.84 (0.79) mm (95% CI 2.4–3.4), in patients with complaints 3.12 (1.21) mm (95% CI 3.0–3.3), and in the comparison group 1.50 (0.49) mm. In the group of patients with asymptomatic adenomyosis, we revealed a decrease in the psychoemotional state parameters, such as general physical well-being 56 (54, 57) points vs. 82 (79, 84) in the comparison group; general mental well-being 51 (45, 53) vs. 86 (86, 87) in the comparison group; mental health 70 (65, 72) vs. 91 (89, 92) in the comparison group; and vital activity 69 (13) vs. 81 (4), respectively. In patients with asymptomatic adenomyosis, the serum progesterone level was 10.77 nmol/L vs. 33.94 nmol/L in the comparison group. The plasma oxytocin level in asymptomatic patients was 134 (21) pg/mL, not differing from that in symptomatic patients 128 (31) pg/mL. In the comparison group, the plasma oxytocin level was lower 100 (33) pg/mL. According to the morphological assessment of the endometrium, only 63% of asymptomatic patients had endometrial histology consistent with the cycle phase. The incidence of endometrial hyperplasia without atypia in the asymptomatic group was 13%.

Patients with asymptomatic adenomyosis demonstrate the absence of obvious symptoms of the disease (dysmenorrhea, pelvic pain syndrome, abnormal uterine bleeding). Frequent detection of endometrial hyperplasia in this group of patients and a decrease in the quality of life compared to women without gynecological diseases dictates the need for a thorough examination of such patients, more frequent follow-up, and joint patient management with related specialists. Full Text About the authors Maria A. Shalina The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-5921-3217 SPIN-code: 6673-2660 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 MD, Dr. Sci. (Medicine), Professor, Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation Russian Federation, Saint PetersburgGulrukhsor Kh. Tolibova The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6216-6220 SPIN-code: 7544-4825 MD, Dr. Sci. (Medicine) Russian Federation, Saint PetersburgTatiana G. Tral The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0001-8948-4811 SPIN-code: 1244-9631 MD, Dr. Sci. (Medicine) Russian Federation, Saint PetersburgReferences - Adenomyosis: an underacknowledged cause of abnormal uterine bleeding and pelvic pain. EBioMedicine. 2025;113:105656. doi: 10.1016/j.ebiom.2025.105656 EDN: CNQUEN - Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. 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