Bibliometric analysis and visualization of adenomyosis

OBJECTIVES: This bibliometric analysis systematically evaluated the research landscape, emerging trends, and key focus areas in adenomyosis to guide future research directions. DESIGN: Performance analysis combined with scientific mapping of global adenomyosis research literature. DATA SOURCES: Web of Science Core Collection (1980-2024). DATA EXTRACTION AND SYNTHESIS: Articles were manually screened. Bibliometrix (R 4.3.0), VOSviewer, and CiteSpace analyzed productivity, collaboration, citation patterns, and research trends. Derived data and analysis scripts are deposited in the Open Science Framework (OSF) under a citable DOI. RESULTS: Among 3100 included publications, China led output (752, 24.26%, full-counted), followed by the United States (414, 13.35%), Japan (350, 11.29%), Italy (215, 6.94%), and South Korea (128, 4.13%). In the 2 adenomyosis-specific corpora, however, the United States ranked first. The US had the highest citations and international collaboration, though international co-authorship among top-producing countries remained low (16.14%). Leading institutions were Fudan University (89), Shandong University (52), and University of Tokyo (49). Top journals by volume: Fertility and Sterility, Human Reproduction, and Journal of Minimally Invasive Gynecology. Research focus shifted from hysterectomy and uterine artery embolization toward high-intensity focused ultrasound (HIFU), and from endothelial nitric oxide synthase/induced adenomyosis toward ectopic endometrium. Eight keyword clusters emerged; the 4 largest (#0 EMT, #1 HIFU, #2 endometrial cancer, #3 pregnancy outcomes) form the present focus. Burst analysis identified "consensus" (2020-2024), "pathogenesis" (2022-2024), and "pregnancy outcome" (2022-2024) as recent and currently active hotspots. CONCLUSIONS: Current adenomyosis research centers on ectopic endometrium and EMT in pathogenesis, fertility outcomes, long-term efficacy of HIFU and fertility-sparing surgery, links to endometrial cancer, and adverse pregnancy outcomes. Beyond deepening pathogenesis and pregnancy-outcome research, key future directions include enhancing international collaboration and developing internationally agreed, evidence-based standardized terminology, diagnostic criteria, and classification systems for adenomyosis.