Adenomyosis and Polycystic Ovary Syndrome in Adolescents and Young Women: More Common Together or Not?

Objectives: This study evaluated the relationship between adenomyosis and polycystic ovary syndrome (PCOS) in adolescents and young adults and compared their clinical and ultrasonographic features when they were present alone or concurrently to support a more comprehensive diagnostic approach. Methods: We retrospectively reviewed the medical records of 319 individuals aged 10–25 years with symptoms suggestive of adenomyosis or PCOS. The participants were grouped as adenomyosis only (n = 29), PCOS only (n = 277), or combined (n = 13). Diagnoses were made via ultrasonography according to international guidelines. The data were analysed via IBM SPSS Statistics v.22. Normality was assessed by the Kolmogorov‒Smirnov test. Independent samples t tests were used for continuous variables; chi-square tests or Fisher’s exact tests were used for categorical variables. P < 0.05 was considered statistically significant. Results: Chronological and gynecologic age did not differ among the groups; however, body mass index was significantly greater in the PCOS group (p < 0.001). Heavy menstrual bleeding (HMB) (34.5% and 61.5%), pelvic pain (24.1% and 38.5%), and dysmenorrhea (89.7% and 69.2%) were significantly more common in the adenomyosis and combined groups than in the PCOS group (all p < 0.001). Uterine wall asymmetry, irregular or interrupted junctional zones (JZs), and echogenic subendometrial lines and buds were also more prevalent in these groups (all p < 0.001). Hyperechoic myometrial islands were the least common ultrasonographic finding (27.6%). Ferriman–Gallwey (FG) scores and free androgen index values were significantly greater in the PCOS group (p < 0.001 and p = 0.029). Conclusions: Adenomyosis and PCOS exhibit distinct clinical and ultrasonographic profiles even in adolescence. Careful ultrasonographic evaluation in PCOS may increase diagnostic accuracy by detecting coexisting adenomyosis, emphasizing the need for early differential diagnosis to guide individualized treatment strategies.