Ultrasound findings of adenomyosis in adolescents: type and grade of the disease.

Abstract Objective: To evaluate the ultrasound features, types and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptoms Study Design: This was a retrospective observational study. Setting: Gynaecological Ultrasound Units from January 2014 to June 2020. Patients: 43 adolescents (aged 12-20) who were diagnosed with adenomyosis at a pelvic ultrasound examination. Intervention: Ultrasound features, location and type of adenomyosis within the uterus were evaluated on stored 2D images and videos and 3D volumes. Adenomyosis was classified as mild, moderate and severe according to the extension of the disease in the uterus as described in our previous published classification. Main Results: Adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas and some types of junctional zone (JZ) alterations. Posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% (19/43) of adolescents with adenomyosis, at least one location of pelvic endometriosis was documented. Dysmenorrhea was the most commonly reported symptoms (88%) and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry and intramyometrial cystic areas. Adolescents with dyspareunia showed diffuse adenomyosis (9/9pts) including both inner and outer myometrium (7/9pts) and located in the posterior wall (7/9pts). Heavy menstrual bleeding was associated with diffuse adenomyosis (18/23pts) mostly of the outer myometrium (22/23pts). Scoring system showed predominantly mild disease and no severe adenomyosis was found. Adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding, compared to those with the focal disease of the inner myometrium. Conclusions: This study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild to moderate form and is associated with typical painful symptoms. In adolescents the diagnosis of adenomyosis is feasible through non-invasive way with ultrasound and a proper management can be set.