Uterine Anteroposterior Diameter as an Imaging Correlate of Dysmenorrhea Severity: Findings Across Symptom Based Clusters

International Journal of Women's Health (Mar 2026) Uterine Anteroposterior Diameter as an Imaging Correlate of Dysmenorrhea Severity: Findings Across Symptom Based Clusters Abstract Jiaye Li,1 Yang Gao,2 Meiling Sun,3 Chun Chen,1 Jiahui Che,4 Ting Zhao1 1Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200433, People’s Republic of China; 2Department of Ultrasound, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200433, People’s Republic of China; 3Department of Gynecology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu Province, 223001, People’s Republic of China; 4Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310020, People’s Republic of ChinaCorrespondence: Ting Zhao, Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200433, People’s Republic of China, Tel +86-15021677129, Fax +86-21-5302-8000, Email [email protected]: Adenomyosis and endometriosis are both recognized as etiological factors in the development of dysmenorrhea; however, their respective contributions to this condition remains ambiguous. This study aims to examine the distinct contributions of adenomyosis and endometriosis to the symptomatology of dysmenorrhea.Patients and Methods: A total of 480 women undergoing laparoscopy for benign conditions were included, among whom 238 were diagnosed with endometriosis and 236 with adenomyosis. Preoperative assessments of general pain severity of dysmenorrhea and 18 specific menstrual symptoms were conducted utilizing the Visual Analog Scale (VAS) and the COX Menstrual Symptom Scale. Symptom clusters were identified using correlation analyses, hierarchical cluster analysis and graphical least absolute shrinkage and selection operator (GLASSO) network analysis. These clusters were further corroborated by examining the varied correlations between symptoms and VAS scores using Spearman correlation, as well as the distinct patterns of how adenomyosis-related key uterine dimension and endometriosis affected these symptoms through logistic regression analysis.Results: Three distinct clusters of menstrual symptoms were identified. One cluster, which included cramps, nausea, vomiting, loss of appetite, stomachache, and insomnia, demonstrated a close correlation with VAS pain scores. The symptoms within this cluster were influence by common influencing factors, particularly increased uterine anteroposterior diameter and the presence of endometriosis, with a consistent pattern. These characteristics substantiate the classification of these symptoms as the core dysmenorrhea cluster. Although endometriosis exacerbated these symptoms, their severity was not further amplified by higher revised American Society for Reproductive Medicine (rASRM) scores.Conclusion: Menstrual symptoms can be primarily categorized into three distinct clusters, with one cluster potentially representing the core symptoms associated with dysmenorrhea. An increased uterine anteroposterior diameter, probably attributed to adenomyosis, serve as a significant imaging correlate of dysmenorrhea severity, while endometriosis primarily acts to exacerbate them.Keywords: adenomyosis, dysmenorrhea, endometriosis, symptom clusters, uterine size