Transvaginal Sonographic Features of Diffuse Adenomyosis and Associated Symptoms in 18-30-Year-Old Nulligravid Women Without Endometriosis: Is Our Diagnosis Still Valid 10 Years Later? A Re-Evaluation of Previous Results.

Background: The introduction of the Morphological Uterus Sonographic Assessment (MUSA) 2022 criteria for diagnosing adenomyosis has reduced diagnoses compared with previous criteria. However, the impact of each ultrasonographic sign on diagnosis and symptom management remains unexplored. Methods: We retrospectively re-evaluated data from our 2015 study, which used criteria available before the first MUSA consensus. Nulligravid women aged 18-30 years without endometriosis were included to determine whether MUSA 2022 criteria result in fewer diagnoses than previous criteria. Sonographic images were reviewed and MUSA 2022 criteria applied. The primary outcome was to estimate previous overdiagnosis; the secondary outcome was to identify correlations between ultrasound features and symptoms. Results: Among 156 patients, at least one direct MUSA 2022 sign was present in 36 women; 17 had only indirect signs; and 103 had no ultrasound signs. MUSA 2022 criteria reduced adenomyosis prevalence from 34% to 23.1%. Direct signs were associated with greater dyspareunia (44.4% vs. 11.8%) and higher VAS scores. Hypermenorrhoea was associated with asymmetrical thickness (Odds Ratio 2.84) and a globular uterus (Odds Ratio 4.03). Conclusions: Applying MUSA 2022 criteria reduces adenomyosis diagnoses, suggesting that previous criteria may have overestimated prevalence. Nevertheless, ultrasound remains an adjunct to clinical assessment, and symptoms should guide management when direct signs are absent.