New sonographic classification of adenomyosis: do type and degree of adenomyosis correlate to severity of symptoms?

Abstract Study Objective to correlate type and degree of adenomyosis, scored through a new system based on transvaginal sonographic (TVS) features, to patient's symptoms and fertility. Design This is a multicenter, observational prospective study. Setting two Endometriosis tertiary referral center (University of Tor Vergata Rome and University of Siena) Patients 108 patients with ultrasonographic signs of adenomyosis Interventions A new ultrasonographic scoring system designed to assess the severity and the extent of uterine adenomyosis was used to stage the disease in correlation with clinical symptoms. Menstrual uterine bleeding was assessed by a pictorial blood loss analysis chart (PBAC), painful symptoms were evaluated using a visual analogue scale (VAS) and infertility factors were considered. Measurement and Main Results 108 patients with ultrasonographic signs of adenomyosis (mean age 37.7±7.7 yrs) were classified according to the proposed scoring system. Women with ultrasound diagnosis of diffuse adenomyosis were older (p= 0.04) and had heavier menstrual bleeding (p=0.04) than women with focal disease, however no statistically significant differences were found regarding presence and severity of dyspareunia and dysmenorrhea. Higher values of menstrual bleeding were found for severe diffuse adenomyosis and the highest values found in those with adenomyomas. In those patients trying to conceive, the presence of ultrasound findings of focal disease was associated with a higher percentage of infertility compared to diffuse disease and the focal involvement of the junctional zone (JZ) showed a higher percentage of at least one miscarriage compared to those with diffuse adenomyosis. Conclusion The ultrasonographic evaluation of the type and extension of adenomyosis in the myometrium seems to be important in correlation to the severity of symptoms and infertility.