Coexisting adenomyosis in endometriosis: Similar pain and quality of life, with longer bleeding and bowel symptoms—A comparative cross‐sectional study

OBJECTIVE: To compare pain, menstrual flow, and quality of life (QoL) between women undergoing surgery for endometriosis only compared with women with endometriosis and coexisting adenomyosis. METHODS: A cross-sectional study, set in two tertiary hospitals, of reproductive-aged women (18-50 years) with a preoperative imaging diagnosis of endometriosis and/or adenomyosis and clinical indication for laparoscopy; all diagnoses were confirmed histologically. Groups were divided into pure endometriosis (n = 60) and endometriosis plus adenomyosis (n = 59) groups. Women responded to standardized questionnaires about demographics, gynecologic, history, and symptoms. Pain was graded by visual analog scale. Menstrual blood loss was assessed using the Pictorial Blood Loss Assessment Chart (PBAC). QoL was measured by the 36-Item Short Form Survey (SF-36) questionnaire. Surgical findings and the American Association of Gynecologic Laparoscopists classification were recorded. MAIN RESULTS: We measured pain intensity, PBAC score and bleeding duration, and SF-36 domains. The adenomyosis group was older (42.3 vs. 37.7 years, P = 0.001), reported longer menstrual bleeding duration (10.5 vs. 6.7 days), and had more cyclical bowel changes (55% vs. 28%). The groups did not differ in overall pain scores, infertility, PBAC categories, or SF-36 domains. In multivariable analysis, older age at laparoscopy (odds ratio [OR], 1.15 [95% confidence interval (CI), 1.06-1.26]; P = 0.002) and longer menstrual bleeding duration (OR, 1.09 [95% CI, 1.02-1.17]; P = 0.010) independently increased the odds of adenomyosis; partial cul-de-sac obliteration was also associated with adenomyosis, whereas complete obliteration was more frequent in pure endometriosis. CONCLUSION: In patients with endometriosis, coexisting adenomyosis did not add to pain or worsen QoL but was linked to longer bleeding and increased bowel symptoms. Management should be individualized and guided primarily by symptom burden and life impact rather than imaging labels alone.