OC13.04: Prevalence of ultrasound features of adenomyosis in asymptomatic premenopausal women

To estimate the prevalence of ultrasound features of adenomyosis in gynecologically asymptomatic premenopausal women 20–39 years old. This is a prospective observational study. 644 volunteers 20–39 years old recruited from a Swedish population registry underwent transvaginal gray scale ultrasound examination on cycle day 4–8. The inclusion criterion was absence of previous or current gynecological complaints or diseases and no history of any type of menstrual disturbance. The women reported their menstruations as not painful, mildly painful or painful. Ultrasound features of adenomyosis were searched for: uterine enlargement and asymmetric thickening of the anterior or posterior myometrial wall, ill-defined endometrial-myometrial junction, myometrial cysts and hypoechogenic linear stripes in the myometrium. A diagnosis of adenomyosis was made on the basis of subjective evaluation of the ultrasound image (pattern recognition). Because all women were asymptomatic, no treatment was suggested and women were not followed up. In 58 (9%) women at least one ultrasound feature of adenomyosis was observed. The most common feature was hypoechogenic linear stripes (n = 32) and ill-defined endometrial-myometrial junction (n = 30). Asymmetrical thickening of the uterus was found in 17 women and myometrial cysts in 5 women. A diagnosis of adenomyosis based on pattern recognition was made in 45 of the 58 (76%) women in whom features of adenomyosis were present. Women with ultrasonographic features of adenomyosis were older than those without (median 33 years vs. 28; p = 0.02). The prevalence of ultrasound features of adenomyosis was similar in women with and without painful menstruation (19% vs. 15%; p = 0.41). Ultrasound features of adenomyosis can be found in about 9% of gynecologically asymptomatic premenopausal women. The clinical importance of ultrasound features of adenomyosis in asymptomatic women is unknown.