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Adenomyosis: MRI Evaluation and Diagnosis

Magnetic resonance imaging for accurate, non-invasive diagnosis of adenomyosis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Adenomyosis: MRI Evaluation and Diagnosis?

Adenomyosis is defined as ectopic endometrial tissue (glands and stroma) located more than 2.5 mm beneath the endometrial-myometrial junction within the myometrium.

It coexists with endometriosis in 30-40% of patients and with leiomyomas in over 40% of cases.

MRI provides the highest diagnostic accuracy non-invasively, with sensitivity 78-88% and specificity 67-93% according to recent meta-analyses.

Symptoms

Heavy menstrual bleeding (menorrhagia, often with clots)
Severe dysmenorrhoea increasing in intensity over years
Chronic pelvic pain, pressure or fullness
Dyspareunia and post-coital pain
Subfertility or recurrent pregnancy loss
Diffuse uterine enlargement on bimanual examination (boggy uterus)
Anaemia from chronic blood loss

Risk Factors

Multiparity and prior caesarean section or uterine surgery (curettage, myomectomy)
Reproductive age 35-50 years (peak incidence)
Tamoxifen therapy increases risk
Previous endometriosis or chronic pelvic inflammatory disease
Smoking is a controversial risk factor
Higher prevalence in patients with infertility or recurrent IVF failure
Genetic predisposition has been suggested

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Heavy or painful periods unresponsive to oral therapy warrant gynaecological evaluation
  • Suspected adenomyosis on transvaginal ultrasound should be confirmed with pelvic MRI
  • Patients with infertility or repeated IVF failure benefit from MRI to rule out adenomyosis
  • Severe pain with anaemia or quality-of-life impact requires multidisciplinary management
  • Imaging review is recommended before any conservative or surgical intervention

Treatment Methods

01
Transvaginal ultrasound is first line: globular uterus, asymmetrical wall thickening, myometrial cysts and venetian blind shadowing suggest the diagnosis
02
Pelvic MRI: junctional zone thickening over 12 mm is the most reliable sign; over 8-12 mm is suspicious
03
MRI subtypes: diffuse adenomyosis (junctional zone over 12 mm in over half of uterine wall), focal (well-defined), adenomyoma (mass-like), cystic (over 5 mm cysts)
04
T2-weighted images show low-signal junctional zone thickening with high-signal foci representing ectopic endometrium
05
Treatment options based on MRI extent: hormonal therapy (combined contraceptives, progestins, levonorgestrel IUD, GnRH agonists)
06
Uterine artery embolisation reduces volume and bleeding for diffuse adenomyosis
07
MRI-guided focused ultrasound for selected focal adenomyosis
08
Hysterectomy remains definitive for women with completed family planning

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.