Autoimmune and inflammatory rheumatic diseases (RDs) are more prevalent in women and often affect gynecological health. Particularly, heavy menstrual bleeding (HMB) and dysmenorrhea are more common in patients with RD. A link between RDs and endometriosis has been shown, whereas the association with adenomyosis remains unexplored. The present study evaluates the prevalence of adenomyosis in women of reproductive age with RD (n = 76) who were referred to the Gynecology Unit, compared with an age-matched control population (n = 305). A detailed clinical history and pelvic imaging findings obtained via transvaginal ultrasound were collected, excluding menopausal women and those with endometriosis or gynecological malignancies. Adenomyosis was significantly more prevalent in RD patients than in controls (40.8% vs. 19.7%, OR 2.81, 95% CI 1.64–4.82; p < 0.001), whereas the prevalence of uterine fibroids did not differ significantly between groups. These findings highlight the need for greater awareness of adenomyosis among both rheumatologists and gynecologists, as timely and adequate recognition is crucial to improving quality of life and reproductive health in patients with RDs.
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