Adenomyosis: Why we need to reassess our understanding of this condition

Hilary Haber
In: OBG Management · 2023 · vol. 35(8) · doi:10.12788/obgm.0303 · W4386648261
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes a 37-year-old woman with a history of recurrent pregnancy loss and painful, heavy periods whose pelvic MRI revealed findings consistent with adenomyosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This article reassesses current understanding of adenomyosis by reviewing evidence on its epidemiology, pathology, potential mechanisms, and diagnostic approaches, including MRI and transvaginal ultrasound (TVUS) findings and how they compare with histopathology from hysterectomy specimens. It highlights that the traditional view of adenomyosis as late-onset and best diagnosed after definitive surgery is misguided, with imaging changes reported in women seeking fertility and in adolescents, and it notes that prevalence estimates vary widely (15% to 67%) due to differing diagnostic methods and inclusion criteria. A key limitation emphasized is that the gold-standard diagnosis relies on invasive hysterectomy specimens, while non-surgical sampling has poor sensitivity and radiologic diagnostic accuracy varies (e.g., MRI pooled sensitivity ~60% and specificity ~96%, with wide sensitivity/specificity ranges; TVUS pooled sensitivity ~81% and specificity ~87% with wide ranges). Relevance to endometriosis: the paper does not discuss endometriosis specifically; it was included in the corpus via a keyword match focused on adenomyosis, a related condition that can share overlapping pelvic pain and infertility presentations.

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Abstract

CASE Painful, heavy menstruation and recurrent pregnancy loss A 37-year-old woman (G3P0030) with a history of recurrent pregnancy loss presents for evaluation.She had 3 losses-most recently a miscarriage at 22 weeks with a cerclage in place.She did not undergo any surgical procedures for these losses.Hormonal and thrombophilia workup is negative and semen analysis is normal.She reports a history of painful, heavy periods for many years, as well as dyspareunia and occasional post-coital bleeding.Past medical history was otherwise unremarkable.Pelvic magnetic resonance imaging (MRI) revealed focal thickening of the junctional zone up to 15 mm with 2 foci of T2 hyperintensities suggesting adenomyosis (FIGURE 1, page 36).How do you counsel this patient regarding the MRI findings and their impact on her fertility?Anatomy of the myometrium

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Condition tags

adenomyosisdyspareunia

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 (36)

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last seen: 2026-06-10T17:14:06.276822+00:00
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