Systemic comorbidities in patients with adenomyosis

How do comorbidities and their prevalence differ between patients with adenomyosis alone and patients with both adenomyosis and endometriosis?

A prospective observational study compared the presence of comorbidities between patients with adenomyosis alone (n = 342) and patients with both adenomyosis and endometriosis (n = 347). Premenopausal patients aged 20-50 years, excluding those with malignant diseases, were studied. The diagnosis of endometriosis or adenomyosis was made by transvaginal ultrasound, magnetic resonance imaging or surgery. Comorbidities were classified as either (i) autoimmune or (ii) stress- and pain-related.

Patients with adenomyosis alone had a significantly lower prevalence of comorbidities compared with patients with both adenomyosis and endometriosis [44.7% (152/342) versus 55.0% (191/34); P = 0.007]. Autoimmune diseases [14% (48/342) versus 23.9% (83/247); P = 0.001] and stress- and pain-related disorders [30.4% (104/342) versus 46.4% (161/347); P < 0.001] were less common in patients with adenomyosis alone compared with patients with both adenomyosis and endometriosis. Patients aged >35 years with adenomyosis alone were less likely to have autoimmune comorbidities compared with patients with both adenomyosis and endometriosis [5.8% (20/48) versus 12.6% (44/347); P = 0.002]. Co-existence of endometriosis was independently associated with the presence of comorbidities among patients with adenomyosis (OR = 1.65, 95% CI 1.12-2.42; P = 0.01).

Patients with adenomyosis alone had a lower prevalence of comorbidities compared with patients with both adenomyosis and endometriosis, suggesting a different clinical profile. More epidemiological data will be useful to explain the low prevalence of some systemic comorbidities in patients with adenomyosis.