Adenomyosis and endometriosis: a differential diagnosis by clinical symptoms

Angela Gallone, Michela Santalucia, Milo Giani, Virginia Manzi, Anna Rosa Speciale, Francesco La Torre, Ernesto Gallucci, Silvia Vannuccini, Felice Petraglia
In: Journal of Endometriosis and Uterine Disorders · 2026 · vol. 14 , pp. 100153 · doi:10.1016/j.jeud.2026.100153 · W7128714600
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Adenomyosis presented with heavy menstrual bleeding, while endometriosis was associated with more severe pain symptoms, and their coexistence resulted in the highest symptom burden.

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Abstract

• Adenomyosis shows a strong association with heavy menstrual bleeding. • Endometriosis is linked to more severe pain-related symptoms than adenomyosis. • Dyspareunia is common in both conditions and lacks discriminatory value. • Coexistence of adenomyosis and endometriosis results in the highest symptom burden. • Distinct symptom patterns support an individualized strategy. Endometriosis and adenomyosis are estrogen-dependent gynecological disorders that share pathogenic mechanisms. Despite their distinct histological and imaging features, the two diseases frequently co-occur and the similar symptoms often complicate diagnosis and management. The aim of the present study was to compare the symptom profiles of women diagnosed with endometriosis, or adenomyosis. A retrospective analysis was conducted on 757 patients evaluated at their first visit, all of whom had not initiated hormonal therapy at the time of assessment. Patients were subdivided into three groups: Group 1 (endometriosis, n = 257), Group 2 (adenomyosis, n = 263), and Group 3 (coexisting endometriosis and adenomyosis, n = 237). Diagnosis was based on histology or imaging with transvaginal ultrasound and magnetic resonance imaging according to standardized criteria. Heavy menstrual bleeding was significantly more frequent in women with adenomyosis (64 %) than in those with endometriosis (19 %) (p < 0.001). When pain symptoms were evaluated, dysmenorrhea (p < 0.032), severe dysmenorrhea (p < 0.005) and chronic pelvic pain (p < 0.021) were more common in endometriosis than in adenomyosis patients. Dyspareunia showed similar prevalence in both groups of patients. Women with both diseases showed the highest overall symptom burden, with more frequent heavy bleeding, dysmenorrhea, severe dysmenorrhea, and pelvic pain. The present findings showed a clear prevalence of heavy menstrual in patients with adenomyosis, while endometriosis patients showed more severe pain symptoms

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Condition tags

endometriosisadenomyosischronic_pelvic_paindysmenorrheadyspareunia

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (21)

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last seen: 2026-06-04T00:00:01.174412+00:00
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