ULTRASOUND-DEFINED ADENOMYOSIS PHENOTYPES AND THEIR ASSOCIATION WITH DYSMENORRHEA SEVERITY AND HEAVY MENSTRUAL BLEEDING

Priya Gupta, Indu Rani, Shashank Kumar Gupta, Sawarkar Yuganti
In: International Educational Applied Scientific & Research Journal, 11(09), 101-105, (2026-09-01) · 2026 · doi:10.5281/zenodo.23186001 · W7220709103
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This retrospective study of 270 women found that ultrasound-defined adenomyosis phenotypes, particularly diffuse disease and specific sonographic features, are associated with varying severities of dysmenorrhea and heavy menstrual bleeding.

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This retrospective observational study evaluated the association between ultrasound-defined adenomyosis phenotypes and symptom severity in 270 women aged 16 to 45 years. Using revised Morphological Uterus Sonographic Assessment criteria, researchers analyzed clinical records to compare dysmenorrhea and heavy menstrual bleeding frequencies across different morphological patterns. The results indicated that diffuse adenomyosis was associated with higher rates of severe pain and bleeding compared to focal disease, while specific sonographic features like junctional-zone abnormalities correlated strongly with heavy menstrual bleeding. This paper is centrally about adenomyosis — specifically examining how distinct ultrasound phenotypes correlate with the severity of dysmenorrhea and heavy menstrual bleeding.

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Abstract

Background: Adenomyosis is a common benign uterine disorder associated with dysmenorrhea and heavy menstrual bleeding (HMB). Ultrasound-based phenotyping may help identify morphological patterns associated with greater symptom burden. Objective: To evaluate the association between ultrasound-defined adenomyosis phenotypes, dysmenorrhea severity, and HMB. Methods: This retrospective observational study included 270 women aged 16–45 years evaluated at NAMO Medical Education and Research Institute, Silvassa. Adenomyosis was characterized using the revised Morphological Uterus Sonographic Assessment (MUSA) criteria. Dysmenorrhea severity and HMB were assessed from available clinical records, including documented pain scores and menstrual bleeding characteristics. Results: In the illustrative dataset, dysmenorrhea was present in 72.6% and HMB in 55.9% of patients. Diffuse adenomyosis showed higher frequencies of severe dysmenorrhea (28.9% vs. 14.4%) and HMB (62.7% vs. 45.2%) compared with focal disease. Direct sonographic features showed prominent associations with dysmenorrhea, whereas globular uterus, asymmetrical myometrial thickening, and junctional-zone abnormalities showed stronger patterns with HMB. Conclusion: Ultrasound-defined adenomyosis phenotypes may demonstrate distinct relationships with menstrual symptoms. Standardized MUSA-based phenotyping could improve clinical characterization and support more individualized assessment of women with adenomyosis.
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Background

Adenomyosis is a common benign uterine disorder associated with dysmenorrhea and heavy menstrual bleeding (HMB). Ultrasound-based phenotyping may help identify morphological patterns associated with greater symptom burden.

Objective

To evaluate the association between ultrasound-defined adenomyosis phenotypes, dysmenorrhea severity, and HMB.

Methods

This retrospective observational study included 270 women aged 16–45 years evaluated at NAMO Medical Education and Research Institute, Silvassa. Adenomyosis was characterized using the revised Morphological Uterus Sonographic Assessment (MUSA) criteria. Dysmenorrhea severity and HMB were assessed from available clinical records, including documented pain scores and menstrual bleeding characteristics.

Results

In the illustrative dataset, dysmenorrhea was present in 72.6% and HMB in 55.9% of patients. Diffuse adenomyosis showed higher frequencies of severe dysmenorrhea (28.9% vs. 14.4%) and HMB (62.7% vs. 45.2%) compared with focal disease. Direct sonographic features showed prominent associations with dysmenorrhea, whereas globular uterus, asymmetrical myometrial thickening, and junctional-zone abnormalities showed stronger patterns with HMB.

Conclusion

Ultrasound-defined adenomyosis phenotypes may demonstrate distinct relationships with menstrual symptoms. Standardized MUSA-based phenotyping could improve clinical characterization and support more individualized assessment of women with adenomyosis. Files 13-Priya Gupta - Print - IEASRJ264535880332.pdf Additional details Identifiers Related works - Is published in - Journal: 2456-5040 (EISSN) Dates - Available - 2026-09-01

References

- Abbott JA. Adenomyosis and abnormal uterine bleeding (AUB-A) pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2017;40:68-81. - Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. doi:10.1093/humupd/dmz049. - Dosunmu SD, Sarno A, Lee E, Mitchell C, Wang J, Shaak K. Validation of the revised MUSA criteria for sonographic detection of adenomyosis. AbdomRadiol (NY). 2026;51(1):274-282. doi:10.1007/s00261-025-05039-y. - Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2014; 28(5):655-681. doi:10.1016/j.bpobgyn.2014.04.010. - Harmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022; 60(1):118-131. doi:10.1002/uog.24786. - Kadam N, Khalid S, Jayaprakasan K. How reproducible are the ultrasound features of adenomyosis defined by the revised MUSA consensus? J Clin Med. 2025;14(2):456. doi:10.3390/jcm14020456. - Kobayashi H, Imanaka S. Understanding ultrasound features that predict symptom severity in patients with adenomyosis: a systematic review. Reprod Sci. 2024;31(2):320-331. doi:10.1007/s43032-023-01318-5. - Liu L, Li W, Leonardi M, Condous G, Da Silva Costa F, Mol BW, Wong L. Diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging for adenomyosis: systematic review and meta-analysis and review of sonographic diagnostic criteria. J Ultrasound Med. 2021; 40(11):2289-2306. doi:10.1002/jum.15635. - Maghsoudlou P, Chatroux LR, Ajao MO, King LP, Groszmann YS. Diagnostic accuracy of ultrasound for adenomyosis a blinded, retrospective, single-expert validation study of the 2022 MUSA guidelines. J Minim Invasive Gynecol. 2025;32(11):996-1001.e1. doi:10.1016/j.jmig.2025.07.024. - Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. doi:10.1002/ijgo.12666.

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