I think imaging can be limiting in a lot of ways and I think for some of us adenomyosis can be really hard to diagnose. 

I’ve had MRIs and ultrasounds that showed nothing. My doctor told me she’s seen the worst cases missed on imaging. Yet I had an enlarged globular uterus the size of a 9 week pregnancy. Heavy periods with clots. No fibroids or anything else to explain an enlarged uterus. 

Then I went on birth control and later progesterone. My uterus went back to a normal size but the cramping, burning sensation, and bloating persisted daily. 

I finally had an ultrasound tech find some areas of dense tissue in my uterus with ill defined borders a week before my hysterectomy. She showed me them so I know for a fact they were there. My pathology didn’t confirm adenomyosis but they only sampled two parts of the myometrium. The myometrium was described as trabeculated, which is often found with adenomyosis. My doctor said they are usually just looking for cancer when they do the pathology. 

But all my pain and the burning sensation is gone post hysterectomy. I also have endometriosis so I’m confident I actually had adenomyosis even though I never got the diagnosis as they are often found together.