Epidemiology

Estimating the prevalence of adenomyosis presents a challenge due to the existence of asymptomatic forms and the lack of standardised histological or imaging-based criteria.[2] The exact prevalence of histologically confirmed adenomyosis varies widely between studies, ranging from 5% to 70% of women undergoing hysterectomy, with most quoting 20% to 35%.[3][4][5] The prevalence of adenomyosis diagnosed on transvaginal ultrasound (TVUS) has been found to range from 21% to 34% based on observational studies of women attending general gynaecology clinics.[6][7] It is estimated that approximatedly 30% of patients with adenomyosis are asymptomatic and may be diagnosed incidentally following hysterectomy or in women with a history of subfertility and/or adverse pregnancy outcomes.[2][8]

Adenomyosis is most commonly definitively diagnosed via histopathology in women between 35 years of age and menopause. Approximately 70% to 80% of women who undergo hysterectomy for adenomyosis are in the fourth or fifth decade of life.[9] However, studies using magnetic resonance imaging (MRI) criteria for diagnosis highlight that adenomyosis can be a cause of dysmenorrhoea and chronic pelvic pain in women of all ages, including adolescents.[10][11]

After menopause, oestrogen deficiency may decrease both symptoms and prevalence of adenomyosis. In one study, premenopausal and perimenopausal women had an increased prevalence of surgically confirmed adenomyosis at baseline compared with postmenopausal women not using hormone therapy (prevalence odds ratio [POR] 4.72, 95% CI 3.22 to 6.91 and 3.40, 95% CI 2.10 to 5.51, respectively).[12]

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