What are the key clinical features that suggest a diagnosis of adenomyosis in a patient presenting with pelvic pain?

When a patient presents with pelvic pain, key clinical features that may suggest a diagnosis of adenomyosis include:

• Dysmenorrhoea: This refers to painful periods, which is a very common and often severe symptom of adenomyosis [Bourdon et al., 2021; Moawad et al., 2023].
• Chronic Pelvic Pain: Persistent pelvic pain, which may not be limited to menstruation, is another significant indicator [Bourdon et al., 2021; Moawad et al., 2023]. This can overlap with symptoms seen in conditions like endometriosis ¹.
• Heavy Menstrual Bleeding (HMB): While the query focuses on pain, HMB is a hallmark symptom of adenomyosis and frequently co-occurs with pelvic pain [Bourdon et al., 2021; Moawad et al., 2023]. NICE guidelines provide assessment and management strategies for HMB ².
• Dyspareunia: Painful sexual intercourse can also be a presenting symptom in patients with adenomyosis [Bourdon et al., 2021; Moawad et al., 2023].

These symptoms arise from the presence of endometrial tissue within the muscular wall of the uterus (myometrium) [Bourdon et al., 2021].