Which imaging modalities are most effective for confirming a diagnosis of adenomyosis in primary care?

Transvaginal ultrasound is the most effective and preferred imaging modality for confirming a diagnosis of adenomyosis in primary care, especially in women presenting with heavy menstrual bleeding and significant dysmenorrhoea or a bulky, tender uterus on examination.

This recommendation is based on NICE guidance which advises offering transvaginal ultrasound in preference to transabdominal ultrasound or MRI for suspected adenomyosis due to its accessibility, diagnostic utility, and suitability for primary care settings.

If transvaginal ultrasound is declined or unsuitable, transabdominal ultrasound or MRI may be considered as alternative imaging options, although these have limitations compared to transvaginal ultrasound.

While MRI can provide detailed pelvic imaging and may be used in specialist settings to assess the extent of adenomyosis or differentiate it from other pathologies, it is not recommended as a first-line diagnostic tool in primary care due to cost, availability, and practicality.

Overall, transvaginal ultrasound remains the frontline imaging modality for adenomyosis diagnosis in primary care, with MRI reserved for complex or unclear cases referred to specialist services.

This approach aligns with the evidence that ultrasound features can reliably suggest adenomyosis, supporting clinical decision-making without immediate need for invasive procedures.

Diagnostic laparoscopy is not routinely used for adenomyosis diagnosis but may be considered if symptoms persist and imaging is inconclusive.

In summary, for primary care confirmation of adenomyosis, transvaginal ultrasound is the most effective imaging modality, followed by transabdominal ultrasound or MRI if necessary.

¹,² (Arnold et al., 1995) (Kalish et al., 2007)