OC16.03: Pre‐ and post‐operative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis

Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre and post-operative symptoms. A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by two-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3–6 months after surgery) was done. A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (p = 0.0019), dyspareunia (p = 0.0004), and abnormal uterine bleeding (P < 0.001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (p < 0.001) in the group with adenomyosis. The association between DIE and adenomyosis detected in our series strongly suggests an accurate pre-therapeutical evaluation of signs and symptoms, and transvaginal ultrasound represents the primary accurate diagnostic tool for the diagnosis. This information should help to develop more effective treatment strategies in women affected by DIE and adenomyosis.