Myometrial disease extent on standardized morphological uterus sonographic assessment transvaginal ultrasound is associated with severe dysmenorrhea in women with adenomyosis: a prospective observational study

Abstract

Background: Aim was to evaluate associations between standardized morphological uterus sonographic assessment (MUSA) transvaginal ultrasound features and dysmenorrhea severity in women with adenomyosis.

Methods: This prospective observational study included 42 consecutive premenopausal women with secondary dysmenorrhea and sonographically diagnosed adenomyosis between March 2025 and March 2026. Standardized transvaginal ultrasound was performed using a GE Voluson E8 system with an 8-MHz transvaginal transducer. MUSA features, disease type, and myometrial disease extent were recorded. Dysmenorrhea was assessed using a 0-10 numerical rating scale. Group comparisons and diagnostic performance measures were evaluated.

Results: Participants had mild (n=16), moderate (n=10), or severe (n=16) dysmenorrhea. Heavy menstrual bleeding, dyspareunia, chronic pelvic pain, several direct MUSA features, and the presence of at least two direct MUSA features increased across symptom groups. Myometrial involvement >50% occurred in 56.3% of women with severe dysmenorrhea versus 6.3% with mild symptoms. For severe dysmenorrhea, disease extent >50% had 56.3% sensitivity, 88.5% specificity, 75.0% positive predictive value, 76.7% negative predictive value, and 76.2% accuracy.

Conclusions: Greater myometrial disease extent was strongly associated with dysmenorrhea severity in this cohort. Standardized reporting of disease extent may add clinically useful information to MUSA-based ultrasound assessment, but larger patient-level studies are required to determine independent predictive value.