Sonographic and Clinical Progression of Adenomyosis and Coexisting Endometriosis: Long-Term Insights and Management Perspectives

<b>Objectives:</b> To evaluate the impact of hormonal therapy on the evolution of painful symptoms in premenopausal women with adenomyosis, with or without concomitant endometriosis, over an 18-month follow-up period. This study aimed to compare the symptomatic progression between treated and untreated patients, highlighting the potential role of medical therapy in symptom control and disease stabilization. Secondary, an objective was to explore sonographic changes within our study population, in parallel with clinical outcomes. <b>Methods:</b> This retrospective observational study, conducted at the Endometriosis Referral Center of the University Hospital of Siena, included 40 women with ultrasound evidence of adenomyosis with and without endometriosis. The population was divided into two groups: 20 patients receiving hormone treatment and 20 not receiving hormone treatment. All patients underwent clinical and ultrasound examinations throughout an 18-month follow-up period, during which types, locations, degrees of disease, and associated symptoms were evaluated. <b>Results:</b> Forty patients enrolled in the study presenting with symptoms such as dysmenorrhea, dyspareunia, and heavy menstrual bleeding were included. A total of 22 patients showed isolated adenomyosis, while 18 adenomyosis and endometriosis both. The mean age was 38.5 years (±4.2 SD), with 57.5% being nulliparous. The types of adenomyosis detected were focal in 25%, diffuse in 50%, and mixed (both focal and diffuse) in 25%. Disease severity was classified as mild in 15%, moderate in 45%, and severe in 40%. After 18 months of continuous hormonal therapy, a reduction in focal adenomyosis was observed in 10%, and an improvement of dysmenorrhea and Heavy Menstrual Bleeding (HMB) was noted, while a slight ameliorating of dyspareunia was detected. In contrast, untreated patients showed either unchanged or worsened symptoms. <b>Conclusions:</b> The findings underscore the value of medical therapy in the management of adenomyosis, supporting current recommendations. Given the heterogeneity of clinical presentations and frequent overlap with endometriosis, a personalized treatment approach remains essential. Further larger-scale, long-term studies are needed to confirm these preliminary results and explore the potential impact on fertility preservation.