{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T13:31:06Z","timestamp":1793712666530,"version":"4.6.1"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010878","name":"AbbVie Biotherapeutics","doi-asserted-by":"publisher","award":["00115992.0"],"award-info":[{"award-number":["00115992.0"]}],"id":[{"id":"10.13039\/100010878","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18\u201352 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294925","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T18:24:50Z","timestamp":1702319090000},"page":"e0294925","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3067-0609","authenticated-orcid":true,"given":"Neal M.","family":"Lonky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Portugal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika L.","family":"Estrada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2821-9744","authenticated-orcid":true,"given":"John","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie B.","family":"Vora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence I.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm G.","family":"Munro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"issue":"5","key":"pone.0294925.ref001","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1034\/j.1600-0412.2003.00097.x","article-title":"Menorrhagia: an update","volume":"82","author":"MK Oehler","year":"2003","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"3","key":"pone.0294925.ref002","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/j.1524-4733.2007.00168.x","article-title":"A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding","volume":"10","author":"Z Liu","year":"2007","journal-title":"Value Health"},{"issue":"3","key":"pone.0294925.ref003","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ijgo.2014.09.027","article-title":"Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey","volume":"128","author":"IS Fraser","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"issue":"6","key":"pone.0294925.ref004","doi-asserted-by":"crossref","first-page":"569.e1","DOI":"10.1016\/j.ajog.2019.02.048","article-title":"The impact of menstrual symptoms on everyday life: a survey among 42,879 women","volume":"220","author":"ME Schoep","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0294925.ref005","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1055\/s-0031-1287661","article-title":"A Five-Year International Review Process Concerning Terminologies, Definitions, and Related Issues around Abnormal Uterine Bleeding","volume":"29","author":"HO Critchley","year":"2011","journal-title":"Seminars in Reproductive Medicine"},{"issue":"3","key":"pone.0294925.ref006","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/ijgo.12666","article-title":"The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. 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