Preoperative and Postoperative Clinical and Transvaginal Ultrasound Findings of Adenomyosis in Patients With Deep Infiltrating Endometriosis

Lucia Lazzeri, Alessandra Di Giovanni, A. Di Giovanni, Caterina Exacoustos, C. Exacoustós, Claudia Tosti, Serena Pinzauti, Mario Malzoni, Felice Petraglia, Errico Zupi
Reproductive sciences (Thousand Oaks, Calif.) · 2014 · vol. 21(8) , pp. 1027–1033 · doi:10.1177/1933719114522520 · PMID:24532217 · W2068290923
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-06 ⓘ

This study found that deep infiltrating endometriosis is often associated with adenomyosis, which significantly impacts preoperative symptoms and postoperative pain.

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This study enrolled 121 women undergoing laparoscopic treatment for deep infiltrating endometriosis (DIE) and assessed preoperative symptoms (dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel and urinary symptoms) alongside 2-dimensional transvaginal ultrasound findings of both DIE and adenomyosis; a follow-up subset of 55 was reassessed 3–6 months after surgery. Nearly half of the DIE patients (59/121; 48.7%) also had ultrasound-detected adenomyosis, and compared with DIE-only patients, those with adenomyosis had significantly higher dysmenorrhea, dyspareunia, and abnormal uterine bleeding preoperatively. After surgery, pain improved overall but remained significantly higher in the adenomyosis group; the main caveat is that adenomyosis diagnosis was based on transvaginal ultrasound rather than histopathology. This paper is centrally about endometriosis—specifically the preoperative and postoperative impact of coexisting ultrasound-diagnosed adenomyosis in women with deep infiltrating endometriosis.

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Abstract

Objectives Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre- and postoperative symptoms.

Materials and methods

A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by 2-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3-6 months after surgery) was done.

Results

A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (P = .0019), dyspareunia (P = .0004), and abnormal uterine bleeding (P < .001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (P < .001) in the group with adenomyosis.

Conclusions

Deep infiltrating endometriosis is frequently associated with adenomyosis, significantly affecting pre- and postoperative symptoms and thus influencing the follow-up management. Similar content being viewed by others

References

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Preoperative and Postoperative Clinical and Transvaginal Ultrasound Findings of Adenomyosis in Patients With Deep Infiltrating Endometriosis. Reprod. Sci. 21, 1027–1033 (2014). https://doi.org/10.1177/1933719114522520 Published: Issue date: DOI: https://doi.org/10.1177/1933719114522520

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