Clinical Manifestations Of Adenomyosis Patients With Or Without Pain Symptoms

Figures & data

Figure 1 Flowchart for the patient selection progress.

Table 1 Pain Characteristics In Patients With Adenomyosis

Variables	Number	Percentage
Total number of patients	291
Pain*
Yes	209	71.8%
No	82	28.2%
Dysmenorrhea
Yes	198	68.0%
No	93	32.0%
Degree of dysmenorrhea* (N=198)
Mild	60	30.3%
Moderate	73	36.9%
Severe	65	32.8%
Progressive worsening (N=198)
Yes	111	56.1%
No	87	43.9%
CPP	70	24.1%
Dyspareunia	24	8.2%
Anorectal pain	7	2.4%

Note: *The degree of pain was defined as mild if VAS was 1–3, moderate if 4–7, severe if 8–10 and none if 0.

Abbreviation: CPP, chronic pelvic pain.

Table 2 The Comparison Between Adenomyosis Patients With Or Without Pain Symptoms

	Pain Group % (No.)	Painless Group % (No.)	P
Number of patients	209	82
Age at diagnose  (Median [IQR], y)	40.0 (34.0–44.0)	42.0 (36.0–46.0)	P=0.009*
Age at onset of disease  (Median [IQR], y)	33.0 (28.0–39.0)	36.0 (30.1–42.0)	P=0.008*
Interval between onset and diagnose  (Median [IQR], d)	4.0 (2.0–8.0)	4.0 (2.0–7.0)	P=0.610
Age of menarche  (Median [IQR], y)	14.0 (9–19)	14.0 (13–15)	P=0.495
Duration of mense  (Median [IQR], d)	5.5 (4.5–6.5)	5.5 (4.5–6.5)	P=0.148
Interval of mense  (Median [IQR], y)	28.0 (26.5–29.0)	29.0 (26.9–29.0)	P=0.355
Gravidity (n)
n=0	20.1% (38)	25.4% (18)	P=0.359
n≥1	79.9% (151)	74.6% (53)
Parity (n)
n=0	30.0% (86)	39.7% (31)	P=0.101
n≥1	70.0% (201)	60.3% (47)
Menorrhagia
Yes	23.9% (50)	25.6% (21)	P=0.763
No	76.1% (159)	74.4% (61)
Rectal irritation
Yes	20.1% (42)	7.3% (6)	P=0.008*
No	79.9% (167)	92.7% (76)
Bladder irritation
Yes	11.0% (23)	6.1% (5)	P=0.202
No	89.0% (186)	93.9% (77)
Pre-surgical HGB  [Median (IQR), g/L]	127 (114–135)	127 (109–137)	P=0.867
Pre-surgical GnRHa
Yes	23.0% (48)	17.1% (14)	P=0.269
No	77% (161)	82.9% (68)
Pre-surgical Ca125 level  [Median (IQR), U/mL]	85.9 (43.0–176.7)	33.2 (16.3–58.5)	P<0.001*
Pre-surgical Ca125 elevated
Yes	80.0% (136)	47.1% (24)	P<0.001*
No	20.0% (34)	52.9% (27)
Pre-surgical Ca199 level  [Median (IQR), U/mL]	18.9 (10.6–42.3)	13.8 (6.8–27.4)	P=0.512
Parameter of ultrasound
Volume of uterus [Median (IQR), cm^3]	129 (82–210)	117 (59–241)	P=0.429
Thicken myometrial layer
Yes	18.7% (39)	2.4% (2)	P<0.001*
No	81.3% (170)	97.6% (80)
Decreased echogenicity in myometrial layer
Yes	51.7% (108)	42.7% (35)	P=0.167
No	48.3% (101)	57.3% (47)
Coexisting EM
Yes	45.0% (94)	23.2% (19)	P=0.001*
No	55.0% (115)	76.8% (63)
Degree of coexisting EM (rAFS)
None or Mild (Stage I+II)	84.2% (21)	86.6% (8)	P=0.087
Moderate and severe (Stage III+IV)	15.8% (73)	13.4% (11)
Coexisting uterine fibroids
Yes	55.0% (115)	65.6% (54)	P=0.092
No	45.0% (94)	34.1% (28)
Coexisting endometrial lesions
Yes	10.0% (21)	9.8% (8)	P=0.940
No	90.0% (188)	90.2% (74)

Note: *The difference reached statistical significance.

Abbreviations: EM, endometriosis; CPP, chronic pelvic pain; GnRHa, gonadotropin-releasing hormone agonist; HBG, hemoglobin; rAFS, staging system revised by American Fertility Society.

Table 3 The Multivariate Analysis By Logistic Regression For Adenomyosis Patients With Pain Symptoms

Variables	P value	OR (95% CI)
Age at diagnosis	0.992	1.001(0.897~1.116)
Age of onset of disease	0.329	0.95(0.857~1.053)
Rectal irritation	0.351	1.721(0.55~5.383)
Pre-surgical CA125 elevated	<0.001*	5.828(2.696~12.599)
Pre-surgical uterine volume	0.172	0.999(0.997~1.001)
Anterior myometrial layer thickened	0.618	1.81(0.176~18.607)
Posterior myometrial layer thickened	0.023*	4.624(1.238~17.272)
Diffused myometrial layer thickened	0.999	/
Coexisting endometriosis	0.763	1.13(0.509~2.509)

Note: *The difference reached statistical significance.