Ultrasound signs of adenomyosis in pregnancy and counselling related to infertility and obstetric outcomes

Bertucci E, Emma Bertucci, Ceffa S, Sofia Ceffa, Danieli A, Alessandra Danieli, Marialaura Diamanti, Diamanti M, Sileo FG, Filomena G Sileo, Tramontano AL, Anna L Tramontano, Carlo Alboni, Alboni C, La Marca A, Antonio La Marca
Minerva obstetrics and gynecology · 2026 · vol. 78(4) , pp. 375–387 · doi:10.23736/S2724-606X.25.05857-9 · PMID:41858207
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This review discusses ultrasound diagnosis of adenomyosis during pregnancy, its impact on fertility and obstetric outcomes, and provides guidance for pre- and post-conception counseling.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This review focuses on ultrasound signs of adenomyosis during pregnancy and outlines counselling considerations related to infertility and obstetric outcomes, using existing evidence on adenomyosis presentation and imaging methods. It summarizes that adenomyosis can be associated with unexplained infertility and with adverse outcomes such as miscarriage and preterm labor, and it emphasizes that pregnancy-related uterine changes can make typical transvaginal ultrasound and MRI features less apparent, creating diagnostic challenges. The paper’s stated limitation is that imaging during pregnancy must be used cautiously because symptoms and uterine findings can overlap with other pregnancy-associated conditions, complicating differentiation. This paper is centrally about adenomyosis — specifically ultrasound features during pregnancy and counselling around fertility and obstetric outcomes.

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Abstract

Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to "unexplained infertility" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.
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JOURNAL TOOLS | | Journal policies | | Publishing options | | eTOC | | To subscribe | | Submit an article | | Recommend to your librarian | ARTICLE TOOLS | | Publication history | | Reprints | | Permissions | | Cite this article as | | Share | YOUR ACCOUNT YOUR ORDERS SHOPPING BASKET Items: 0 Total amount: € 0,00 HOW TO ORDER YOUR SUBSCRIPTIONS YOUR ARTICLES YOUR EBOOKS COUPON ACCESSIBILITY REVIEW Minerva Obstetrics and Gynecology 2026 Mar 20 DOI: 10.23736/S2724-606X.25.05857-9 Copyright © 2025 EDIZIONI MINERVA MEDICA language: English Ultrasound signs of adenomyosis in pregnancy and counselling related to infertility and obstetric outcomes Emma BERTUCCI 1 ✉, Sofia CEFFA 2, Alessandra DANIELI 2, Marialaura DIAMANTI 2, Filomena G. SILEO 1, Anna L. TRAMONTANO 3, Carlo ALBONI 2, Antonio LA MARCA 2 1 Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy; 2 Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy; 3 Neurosciences and Reproductive Sciences Department, University Hospital Federico II, Naples, Italy Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to “unexplained infertility” and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring. KEY WORDS: Adenomyosis; Pregnancy; Infertility; Uterus; Ultrasonography; Spontaneous abortion

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Condition tags

adenomyosisinfertility

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

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