Introduction: We aimed to determine the prevalence of pathology confirmed adenomyosis in women with chronic pelvic pain (CPP) who underwent surgical management with total hysterectomy, and to identify associated risk factors and demographic variables. Methods: This is a retrospective cohort study involving 1186 patients treated in a CPP-specialty clinic who underwent surgical management with hysterectomy between January 2010 and December 2021. Results: About 532/1186 (44.9%) of the cohort were diagnosed with adenomyosis on pathology following total hysterectomy. The average age of patients with adenomyosis was older than those without adenomyosis [41 years vs 38 years ( p < 0.001)]. There were no statistically significant differences in symptoms of menstrual bleeding, pelvic pain, dysmenorrhea, or dyspareunia. Those with adenomyosis were more likely to be Hispanic ( p < 0.001), have a history of pregnancy ( p < 0.001), and have chronic cervicitis ( p = 0.037). Uterine weight was significantly higher in the group with adenomyosis ( p = 0.033) especially when excluding leiomyoma ( p = 0.006). Discussion: The prevalence of adenomyosis on surgical pathology in a CPP cohort was higher than that reported for the general population. Uterine weights are higher in adenomyosis, even when controlling for leiomyoma. Classically attributed symptoms of adenomyosis were not useful predictors for the disease.

Endometriosis is a common condition associated with chronic pelvic pain and infertility. Its pathogenesis is poorly understood, diagnosis relies on laparoscopy, and staging is based on extent of disease. Unfortunately, the current staging systems do not correlate well with pain severity and impact, nor do they predict prognosis, i.e., treatment success and recurrence of disease. In this article, we discuss the strengths and limitations of current staging systems and propose modifications that will enable better classification systems to be developed in the future.