Symptom Burden in Adenomyosis: A Comparative Analysis With Peritoneal and Deep Infiltrating Endometriosis
Elvin Piriyev1,2, Clara Mennicken2,3, Sven Schiermeier4
1University Witten-Herdecke, Witten, Germany; piriyev.elvins@gmail.com.
In Vivo (Athens, Greece)
|April 28, 2026
Summary
Adenomyosis (AM) presents a symptom burden similar to endometriosis. This study found isolated adenomyosis causes comparable pain and dyspareunia to peritoneal disease and deep infiltrating endometriosis (DIE).
Area of Science:
- Gynecologic Surgery
- Pelvic Pain Research
- Women's Health
Background:
- Adenomyosis (AM) often coexists with endometriosis, sharing symptoms.
- The distinct symptom burden of isolated adenomyosis requires definition.
- Comparing symptom severity in isolated AM versus endometriosis types is crucial.
Purpose of the Study:
- To compare symptom severity and distribution in isolated adenomyosis versus peritoneal/ovarian endometriosis and deep infiltrating endometriosis (DIE).
Main Methods:
- Retrospective analysis of preoperative symptom questionnaires from 231 women undergoing surgery for suspected endometriosis.
- Intraoperative classification using the #ENZIAN system into isolated AM, peritoneal/ovarian endometriosis, and DIE groups.
- Statistical comparison of symptom prevalence and severity across the three groups.
Main Results:
- Dysmenorrhea was near-universal (95-100%) across all groups.
- Isolated AM and peritoneal/ovarian endometriosis showed higher rates of chronic pelvic pain and severe dyspareunia compared to DIE (p<0.05).
- DIE was associated with increased ovarian involvement and tubo-ovarian adhesions (p<0.001); GI symptoms were similar across groups.
Conclusions:
- Adenomyosis (AM) is associated with a significant symptom burden comparable to peritoneal endometriosis and DIE.
- These findings emphasize adenomyosis as a key contributor to pelvic pain.
- Early recognition and management of adenomyosis are essential for effective patient care.
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