Adenomyosis: Still largely under-diagnosed
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Adenomyosis is frequently under-diagnosed due to a lack of comprehensive patient history and reliance on limited ultrasound findings, hindering effective management of abnormal uterine bleeding and pelvic pain.
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Abstract
Underlying adenomyosis is often the cause of treatment failure for patients undergoing Mirena insertion, endometrial ablation and/or hysteroscopic resection for abnormal uterine bleeding and/or pelvic pain. In this cohort of abnormal uterine bleeding, clinicians rarely considered adenomyosis as a differential diagnosis. In such cases, gynaecologists concentrated primarily on menstrual flow. Symptoms of pelvic pain, dyspareunia, pelvic pressure symptoms and type of dysmenorrhoea were not queried. Frequently, no correlation was sought to account for a uterus noted to be enlarged either clinically or at hysteroscopy. Given the limitation of ultrasound scan (USS) in diagnosing adenomyosis, and gynaecologists' reliance on USS findings, adenomyosis often remains undiagnosed before a hysterectomy. An earlier diagnosis of adenomyosis requires a good history, correlation of clinical examination and ultrasound scan findings and a back-up MRI service. Once adenomyosis is suspected, women can be appropriately counselled so that they are fully aware of the possible failure of conservative management. If conservative management is chosen, they should be followed-up and hysterectomy offered for persistent symptoms.
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References (9)
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Cited by (20)
- Targeted next-generation sequencing for the detection of cancer-associated somatic mutations in adenomyosis 2023
- Uterine Embolization as a New Treatment Option in Adenomyosis Uteri 2022
- Endometriosis - Recent Advances, New Perspectives and Treatments 2021
- Epidemiology of Adenomyosis 2020
- Laparoscopic treatment of a large cystic adenomyosis of the uterus: A case report 2020
- Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy 2019
- Three-dimensional transvaginal ultrasonographic and power Doppler features of adenomyosis : Are they related to symptoms? 2019
- Inter‐rater agreement in the diagnosis of adenomyosis by 2‐ and 3‐dimensional transvaginal ultrasonography 2018
- Deep Adenomyosis 2017
- The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis 2017
- Adenomyosis and Hysteroscopy: An Up-to-Date Review 2017
- Adenomyosis and Hysteroscopy: An Up-to-Date Review 2017
- Endometriotic Pain Is Associated with Adenomyosis but Not with the Compartments Affected by Deep Infiltrating Endometriosis 2016
- Distinct types of uterine adenomyosis based on laparoscopic and histopathologic criteria 2014
- Adenomyosis: A Challenge in Clinical Gynecology 2012
- Norethindrone Acetate in the Medical Management of Adenomyosis 2012
- Intermittent low back pain referred from a uterine adenomyosis: a case report 2011
- Coexistence of adenomyosis in women operated for benign gynecological diseases 2011
- Imaging dell’endometriosi 2010
- Three-dimensional ultrasound versus office hysteroscopy in assessment of pain and bleeding with intrauterine contraceptive device 2010
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- europepmc
- last seen: 2026-06-13T06:22:48.782012+00:00
- openalex
- last seen: 2026-06-10T17:14:06.276822+00:00
- pubmed
- last seen: 2026-05-13T22:13:59.677786+00:00
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