Adenomyosis and endometriosis: a differential diagnosis by clinical symptoms

• Adenomyosis shows a strong association with heavy menstrual bleeding. • Endometriosis is linked to more severe pain-related symptoms than adenomyosis. • Dyspareunia is common in both conditions and lacks discriminatory value. • Coexistence of adenomyosis and endometriosis results in the highest symptom burden. • Distinct symptom patterns support an individualized strategy. Endometriosis and adenomyosis are estrogen-dependent gynecological disorders that share pathogenic mechanisms. Despite their distinct histological and imaging features, the two diseases frequently co-occur and the similar symptoms often complicate diagnosis and management. The aim of the present study was to compare the symptom profiles of women diagnosed with endometriosis, or adenomyosis. A retrospective analysis was conducted on 757 patients evaluated at their first visit, all of whom had not initiated hormonal therapy at the time of assessment. Patients were subdivided into three groups: Group 1 (endometriosis, n = 257), Group 2 (adenomyosis, n = 263), and Group 3 (coexisting endometriosis and adenomyosis, n = 237). Diagnosis was based on histology or imaging with transvaginal ultrasound and magnetic resonance imaging according to standardized criteria. Heavy menstrual bleeding was significantly more frequent in women with adenomyosis (64 %) than in those with endometriosis (19 %) (p < 0.001). When pain symptoms were evaluated, dysmenorrhea (p < 0.032), severe dysmenorrhea (p < 0.005) and chronic pelvic pain (p < 0.021) were more common in endometriosis than in adenomyosis patients. Dyspareunia showed similar prevalence in both groups of patients. Women with both diseases showed the highest overall symptom burden, with more frequent heavy bleeding, dysmenorrhea, severe dysmenorrhea, and pelvic pain. The present findings showed a clear prevalence of heavy menstrual in patients with adenomyosis, while endometriosis patients showed more severe pain symptoms