Prevalence of adenomyosis in symptomatic adolescents and young women: a systematic review and meta-analysis

Objective

Many adolescents and young women experience dysmenorrhea, a condition that is often trivialized or overlooked but can cause a substantial deterioration in health-related quality of life. Therefore, we conducted a systematic review and meta-analysis to investigate the overall prevalence of symptomatic individuals with ultrasound/magnetic resonance imaging–diagnosed adenomyosis in the 12–25 year-age group. This could inform management and treatment decisions.

Evidence Review

The PubMed/Medline, Embase, and Scopus databases were searched for full-length, English-language reports published between 2015 and 2024. This systematic review with meta-analysis was conducted and reported following the Joanna Briggs Institute methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. We included observational studies that assessed the number of patients with adenomyosis among adolescents and young women, the majority of whom presented with dysmenorrhea. The methodological quality of the included studies and their potential risk of bias were ascertained using the Joanna Briggs Institute Critical Appraisal Tool for Prevalence Studies. The main outcome was the prevalence of adenomyosis among symptomatic adolescents (midpoint of the study age range, <20 years) and young women (midpoint of the study age range, ≥20 years). Three meta-analyses, categorized by age, were performed using Stata to pool adenomyosis prevalence data from selected studies. The risk of endometriosis in women with and without adenomyosis was ultimately assessed as an exploratory and confirmatory investigation by combining the odds ratio estimates from each study using the random-effects model.

Results

Six studies comprising 1,300 individuals met the inclusion criteria. The prevalence of adenomyosis ranged from 5.9% to 46.0%, with an overall weighted mean of 20.7% (95% confidence interval [CI], 11.5–31.6) with high heterogeneity (I² = 94.8%). The aggregate estimates were as 16.9% (95% CI, 8.8%–27.0%) in the adolescent subgroup and 29.7% (95% CI, 17.5%–43.5%) in the young woman subgroup. The risk of endometriosis in patients with adenomyosis was significantly higher than that in patients without adenomyosis, with a pooled odds ratio of 3.39 (95% CI, 2.11–5.45), without statistically significant heterogeneity across studies.

Conclusion

The findings of the present review should assist clinicians in developing a high index of suspicion for adenomyosis when adolescents and young women present with chronic severe dysmenorrhea and menorrhagia. Limiting the diagnostic delay and considering secondary prevention medical interventions may improve the quality of life and limit the risk of disease progression. Further rigorous prospective analytic studies are required to better define the epidemiological patterns of adenomyosis in the postmenstrual decade in different population subgroups.