Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease

J Minim Invasive Gynecol. 2022 Feb;29(2):291-299.e1. doi: 10.1016/j.jmig.2021.08.023. Epub 2021 Aug 28.


Study objective: To evaluate the ultrasound features, types, and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptoms DESIGN: A retrospective observational study.

Setting: Gynecological ultrasound units from January 2014 to June 2020.

Patients: A total of 43 adolescents (aged 12-20 years) who were diagnosed as having adenomyosis at a pelvic ultrasound examination.

Interventions: Ultrasound features and location and type of adenomyosis within the uterus were evaluated on stored 2-dimensional images and videos and 3-dimensional volumes. Adenomyosis was classified as mild, moderate, and severe according to the extension of the disease in the uterus as described in our previous published classification.

Measurements and main results: Adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas, and some types of junctional zone alterations. The posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% of adolescents (19/43) with adenomyosis, at least 1 location of pelvic endometriosis was documented. Dysmenorrhea was the most commonly reported symptoms (88%), and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry, and intramyometrial cystic areas. Adolescents with dyspareunia showed diffuse adenomyosis (9/9 patients) including both the inner and outer myometrium (7/9 patients) and in the posterior wall (7/9 patients). Heavy menstrual bleeding was associated with diffuse adenomyosis (18/23 patients) mostly of the outer myometrium (22/23 patients). Scoring system showed predominantly mild disease and no severe adenomyosis was found. Adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding compared with those with the focal disease of the inner myometrium.

Conclusion: This study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild-to-moderate form and is associated with typical painful symptoms. In adolescents, the diagnosis of adenomyosis is feasible through a noninvasive way with ultrasound and a proper management can be set.

Keywords: Adenomyosis; Adolescence; Diagnosis; Pain; Ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Adenomyosis* / complications
  • Adenomyosis* / diagnostic imaging
  • Adolescent
  • Adult
  • Child
  • Dysmenorrhea / diagnostic imaging
  • Dysmenorrhea / etiology
  • Endometriosis* / pathology
  • Female
  • Humans
  • Myometrium / diagnostic imaging
  • Myometrium / pathology
  • Ultrasonography / methods
  • Uterus / diagnostic imaging
  • Uterus / pathology
  • Young Adult