As a common condition that affects up to 10 percent of gynecology patients, adenomyosis occurs when the endometrium grows into the myometrium. Though relatively benign, this condition can negatively affect a patient's fertility and quality of life.
However, by using adenomyosis ultrasound findings, clinicians can quickly and accurately make diagnostic decisions to inform treatment planning as early as possible. Consider the following frequently asked questions to explore the utility and real-life applications of ultrasound in diagnosing adenomyosis.
- Why are many providers turning to adenomyosis ultrasound findings instead of MRI? Ultrasound was once considered a secondary tool for diagnosing adenomyosis. However, thanks to its widespread availability, low cost and quick exam time, it has now surpassed MRI as the gold standard for detecting the condition. This evolution has brought detailed ultrasound guidelines for diagnosing adenomyosis, including a classification and reporting system based on the morphological uterus sonographic assessment criteria.
- What are the best practices for using ultrasound to confirm adenomyosis symptoms? Patients with adenomyosis tend to report dysmenorrhea, menorrhagia and chronic pelvic pain. Because some of these symptoms overlap with those of endometriosis and uterine fibroids — which often coexist with adenomyosis — ultrasound can help detect specific abnormalities that confirm the correct diagnosis. These abnormalities include myometrial cysts, fan-shaped shadowing, asymmetrical thickening greater than 1.5 cm and other criteria.
- How can providers use ultrasound to differentiate adenomyosis pain from other conditions? When severe menstrual pain is caused by adenomyosis, it tends to present on transvaginal ultrasound via four distinct characteristics: an enlarged uterus, inhomogeneous myometrial echotexture, cystic anechoic spaces in the myometrium and an obscure endometrial/myometrial border. Assessing the degree of pain along with the number of these features seen on ultrasound can help providers make an accurate diagnosis and plan treatment.
- What is the connection between adenomyosis and infertility? There are many ways in which adenomyosis can impact a patient's fertility, whether they conceive spontaneously or with assisted reproductive technology (ART). Notably, adenomyosis can affect implantation and endometrial receptivity. It is also thought to impact fertility due to uterine structural factors, disruptions to peristaltic contractions and an abnormal inflammatory response that can be toxic to embryos. An accurate diagnosis, aided by transvaginal ultrasound, can help clinicians determine the best path forward.
- Is there a link between adenomyosis and pregnancy loss? Although confirming a causal link between adenomyosis and miscarriage is difficult due to confounding factors such as advanced maternal age and obesity present in the research, many studies have shown associations between the condition and pregnancy loss for both in vitro fertilization (IVF) and spontaneous conception. However, patients who receive an early diagnosis and intervention before getting pregnant may have improved outcomes. Transvaginal 3D ultrasound is considered a standard tool to diagnose adenomyosis.
When a patient has adenomyosis or other problems associated with reproductive health, it is important to seek out the most accurate means possible to make diagnostic decisions — especially given the time-sensitive nature of certain interventions, such as IVF or other ART options.
