ArticleFrontiers in endocrinology2026
Association between adenomyosis subtypes and concurrent endometrial lesions: a propensity score-matched retrospective study.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adenomyosis is increasingly recognized as a heterogeneous syndrome comprising focal and diffuse subtypes. While adenomyosis is known to be associated with endometrial lesions, it remains unclear whether this risk varies between specific phenotypes. This study aimed to evaluate the association of the diffuse adenomyosis phenotype with the risk of co-existing endometrial lesions using propensity score matching (PSM). Methods: A retrospective study was conducted on 685 patients with confirmed adenomyosis between January 2018 and December 2023. Patients were classified into focal (Fo-ADS, n=404) and diffuse (Di-ADS, n=281) subtypes. To minimize selection bias from baseline confounders, a 1:1 PSM was performed based on age, body mass index (BMI), parity, pain severity, CA125 levels, and history of endometriosis. Multivariate conditional logistic regression and subgroup analyses were employed to determine the correlated risk of endometrial lesions. Results: Prior to matching, Di-ADS patients were significantly older, had a higher BMI, greater parity, and more severe pain, but exhibited a lower prevalence of coexisting endometriosis compared to the Fo-ADS group. The overall incidence of endometrial lesions was significantly higher in the Di-ADS group (49.5% vs. 35.6%, P<0.001). After successfully matching 188 patient pairs (n=376), all baseline covariates were optimally balanced. Conditional logistic regression demonstrated that diffuse adenomyosis remained a significant risk factor for concurrent endometrial lesions (adjusted odds ratio [aOR] = 2.05, 95% CI: 1.28~3.27, P = 0.003). Subgroup analysis revealed a marginal interaction for age (P for interaction = 0.058), with a potentially stronger association observed in woman aged ≤45 years (P <.001). Conclusions: Focal and diffuse adenomyosis represent distinct clinical phenotypes. Diffuse adenomyosis is associated with an increased risk of endometrial lesions, irrespective of age and metabolic factors. Vigilant endometrial surveillance is strongly mandated for patients with diffuse adenomyosis, particularly in women aged 45 years or younger.
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