Factors Influencing Adenomyosis Progression

Presence and/or worsening of painful symptoms, such as severe dysmenorrhea, dyschezia and chronic pelvic pain, as well as the presence of focal adenomyosis of the outer myometrium in women with adenomyosis increase the risk of disease progression, according to a study published in the International Journal of Gynecology & Obstetrics.¹

This prospective, observational, cohort study was undertaken at a tertiary referral center in Italy to assess the clinical progression of adenomyosis using ultrasound and clinical data over a period of one year. Patients diagnosed with adenomyosis via ultrasound from May 2022 to August 2022 were enrolled for the study. Demographic, clinical, and ultrasound data were collected at baseline (T0). Data for these parameters was again gathered at 12 months (T¹).

The study group was categorized into two groups based on the progression of adenomyosis at T1: the Progression Group with patients who experienced a significant increase in uterine volume, specifically greater than 20% and the Stability/Regression Group with patients whose uterine volume either decreased or increased by 20% or less at T¹. Both groups were similar in terms of baseline data.

In the study, the overall rate of adenomyosis progression, the primary study outcome, was 21.3%, with 47 out of 221 patients showing a significant increase in uterine volume (>20%) at T¹. The rate was higher (30.7%) in hormonally untreated women, whereas it was lower (18.3%) in hormonally treated women.

The secondary study outcomes were clinical factors associated with the progression of adenomyosis. Presence of focal adenomyosis of the outer myometrium, moderate to severe dysmenorrhea, chronic pelvic pain, dyschezia, and worsening of chronic pelvic pain were associated with progression of adenomyosis.

This study has identified specific clinical symptoms and features that were linked to a greater likelihood of disease progression over time. Their presence in a patient with adenomyosis might help identify at-risk patients allowing more tailored follow-ups and individualized management strategies. Also, the rate of progression was lower among hormonally treated women suggesting that hormonal treatment may play a role in reducing the progression of adenomyosis.

Reference

1.   Borghese G, et al. Progression of adenomyosis: Rate and associated factors. Int J Gynaecol Obstet. 2024 Oct;167(1):214-222. doi: 10.1002/ijgo.15572.