Triple Gynecological Disease: Endometriosis, adenomyosis and myomatosis

Abstract

INTRODUCTION: The concept of “triple gynaecological disease” describe the coexistence of endometriosis, adenomyosis, and uterine leiomyomatosis, entities that share pathophysiological mechanisms and clinical overlap. Magnetic resonance imaging (MRI) with a dedicated endometriosis mapping protocol represents an integral tool for their simultaneous evaluation. PRIMARY OBJECTIVE: To retrospectively evaluate the frequency and distribution pattern of the coexistence of endometriosis, adenomyosis, and uterine leiomyomas (UL) in MRI studies performed using a dedicated endometriosis mapping protocol. SECONDARY OBJECTIVES: To analyze morphological correlations and highlight the diagnostic value of MRI for the simultaneous detection of these pathologies. METHODS: Two databases from Instituto Doyenne were retrospectively analyzed, including reproductive-age women with clinical suspicion of endometriosis, adenomyosis, or uterine leiomyomatosis. Individual and combined MRI findings were reviewed. RESULTS: A total of 419 patients were evaluated. Adenomyosis was identified in 90.9% of cases, leiomyomatosis in 28.6%, and 24.8% met criteria for “triple pathology.” Intramural fibroids were the most frequent subtype (60%). Deep infiltrating rectal endometriosis was identified in 39.1% of cases, with C2 nodules (1–3 cm) being the most prevalent. Adenomyosis was significantly associated with a lower probability of superficial endometriosis (OR 0.129; p=0.001). DISCUSSION: The significant coexistence of these pathologies supports the concept of “triple gynecological disease” and emphasizes the need for an integral diagnostic approach using MRI.