New guidance on adenomyosis, an overlooked uterine condition affecting 1 in 3 women

A University of Hawaiʻi at Mānoa physician is working to change how a common but often overlooked gynecologic condition is diagnosed and treated. Kimberly Kho, who holds the nation’s first professorship in advanced gynecological surgery in the John A. Burns School of Medicine (JABSOM), authored a clinical expert series review on adenomyosis in Obstetrics & Gynecology. The publication places Kho among a select group of internationally recognized experts in women’s health.

“These articles are meant to synthesize the existing medical literature and turn it into meaningful clinical guidance,” Kho said. “The goal is that a physician could read it, deepen their understanding of the disease, and immediately apply what they learned in their practice on Monday morning.”

Adenomyosis occurs when tissue similar to the lining of the uterus grows into the uterine muscle, causing severe menstrual bleeding, chronic pelvic pain and fertility challenges. Despite affecting roughly one in three women, the condition remains underdiagnosed and under-researched.

“It’s astonishing how common it is,” Kho said. “But if you look at the research funding for adenomyosis, which then correlates to our scientific understanding of the disease and specific therapies, it’s just a drop in the proverbial bucket compared to how much and how many this disease impacts.”

Advances in diagnosis, care

Kho’s review provides a practical roadmap for OB-GYN physicians, covering disease mechanisms, diagnostic advances and modern treatment options. A major shift highlighted is the move toward noninvasive diagnosis using imaging tools such as ultrasound and MRI, rather than relying on hysterectomy for confirmation.

“Our paradigm for diagnosing has really evolved because our technologies have evolved. This allows us to name the condition and start treating it, rather than the alternative, which was often to write off the symptoms,” Kho said.

The review also challenges the idea that hysterectomy is the only effective treatment.

“There are many excellent uterine-preserving options,” Kho said. “Medical, interventional and surgical treatments can manage symptoms while preserving uterine function and future fertility.”

Kho hopes the publication will help establish clearer guidance for physicians worldwide while expanding access to advanced gynecologic care in Hawaiʻi.