Gray matter alterations and pain-related emotional processing in patients with adenomyosis-associated dysmenorrhea: a neuroimaging perspective.

Background: Adenomyosis is a prevalent gynecological condition among women of reproductive age and is commonly associated with heavy menstrual bleeding, severe dysmenorrhea, and infertility. These symptoms impose a substantial burden on both physical health and psychological well-being. Despite increasing recognition of its clinical impact, it remains unclear whether dysmenorrhea in adenomyosis is accompanied by structural brain alterations. Therefore, the present study aims to investigate whether adenomyosis-related dysmenorrhea is associated with changes in brain structure. Understanding such alterations may provide novel insights into the neural mechanisms underlying chronic pain and emotional disturbances in affected patients. Methods: Fifty-one patients with adenomyosis-associated dysmenorrhea (AAD) and 51 demographically matched healthy controls (HCs) were recruited. Voxel-based morphometry was used to identify differences in gray matter volume (GMV). Between-group differences were analyzed using two-sample Results: Compared with HCs, patients with AAD exhibited significant GMV changes in the right fusiform gyrus, right parahippocampal gyrus, right lingual gyrus, left superior frontal gyrus, and bilateral thalamus. Notably, decreased GMV in the right fusiform and right parahippocampal gyri was significantly correlated with pain and emotional scale scores. Conclusions: The observed gray matter abnormalities may underlie the neural mechanisms of pain and emotional disturbances in patients with AAD. These findings enhance our understanding of the brain's role in the interaction between chronic pain and emotional symptoms in AAD.