Clinical recommendation	Evidence rating	Comments
Use transvaginal ultrasonography or pelvic magnetic resonance imaging to noninvasively diagnose adenomyosis.6,9	C	Diagnostic accuracy studies
Patients with adenomyosis not desiring pregnancy can use a levonorgestrel-releasing intrauterine system (Mirena) to help reduce heavy menstrual bleeding and pain.6	B	Results from a limited cohort study showing decreased blood loss and pain
Hysterectomy is definitive treatment of adenomyosis for women who are past childbearing age if other therapies are not effective.6	C	Consensus opinion