Association between ultrasound features of adenomyosis and severity of menstrual pain.
OBJECTIVE
To investigate the association between the ultrasound features of adenomyosis and the severity of menstrual pain.


METHODS
This was a prospective observational study set in the general gynecology clinic of a university teaching hospital between January 2009 and January 2010. A total of 718 consecutive premenopausal women aged between 17 and 55 years attended the clinic and underwent structured clinical and transvaginal ultrasound examinations in accordance with the study protocol. Morphological features of adenomyosis on ultrasound scan were recorded systematically. A quantitative assessment of menstrual pain was made by completion of a numerical rating scale (NRS).


RESULTS
One hundred and fifty-seven (21.9% (95% CI, 18.8-24.9%)) women were diagnosed with adenomyosis on ultrasound. Multiple linear regression analysis showed that an ultrasound diagnosis of adenomyosis and ultrasound and laparoscopic diagnoses of endometriosis were significantly associated with menstrual pain when measured by an NRS. In addition, there was a statistically significant positive correlation between the severity of menstrual pain and the number of ultrasound features of adenomyosis seen.


CONCLUSIONS
Women with ultrasound features of adenomyosis have more severe menstrual pain than do women without these features. The positive correlation between the number of ultrasound features of adenomyosis and the severity of menstrual pain could form the basis of a clinically relevant grading system for adenomyosis. A classification of severity of adenomyosis based on the number of ultrasound features present is a novel concept that should be evaluated prospectively in different populations. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
J
J
Naftalin
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
W
W
Hoo
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
N
N
Nunes
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
T
T
Holland
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
D
D
Mavrelos
Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK.
D
D
Jurkovic
D062788:Adenomyosis / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D004412:Dysmenorrhea / Q000453:epidemiology*; D004715:Endometriosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D014463:Ultrasonography; D055815:Young Adult
adenomyosis; endometriosis; painful periods; transvaginal ultrasound