Correlation between Severity of Symptoms in Patients with Adenomyosis and Transvaginal Ultrasound Criteria

Background: In adenomyosis, a condition that relies on estrogen, stromal fibroblasts and endometrial epithelial cells grow abnormally in the myometrium, either as extensions of the endometrium or as islands encircled by hypertrophic smooth muscle cells. Aim: To find a correlation between the severity of symptoms in patients with adenomyosis and transvaginal US criteria. Subjects and methods: This observational study was carried out on 82 premenopausal women recruited from the outpatient clinic of Al-Zhraa University Hospital, Al-Azhar University, Cairo, Egypt, from Sep 2024 to Sep 2025. Results: Significant differences were found in parity, history of infertility, and previous cesarean section. Patients with severe symptoms were more likely to be nulliparous (66.7%) and have a history of infertility (66.7%). In contrast, patients with moderate symptoms were more likely to have had previous cesarean sections (65.2%). The differences in parity and history of infertility were highly significant (p<0.001), while the difference in previous cesarean section was significant (p=0.007). These findings suggest that certain obstetric factors may be associated with the severity of symptoms in patients with adenomyosis. Conclusion: Symptom severity was significantly associated with longer symptom duration, nulliparity, infertility history, and absence of cesarean section. These findings highlight the value of transvaginal ultrasound not only as a diagnostic tool but also as a potential predictor of symptom burden in adenomyosis. Incorporating both clinical and imaging data may improve individualized management and treatment strategies for affected women.