OB-GYN
Research
For many women, severe pelvic pain and heavy bleeding are symptoms they’re told to simply endure. However, a new publication from Kimberly Kho, MD, MPH, MSc, FACOG, aims to change how doctors diagnose and treat one often-overlooked condition behind those symptoms.
Building on this need for change, Kho, a gynecologic surgeon and professor at JABSOM, recently authored a Clinical Expert Series review on adenomyosis in "The Green Journal" Obstetrics & Gynecology (2026 Impact Factor: 4.7). The invitation to write the review places Kho among a select group of physicians recognized internationally for their expertise 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 is a common but frequently misunderstood condition that occurs when tissue similar to the lining of the uterus grows into the muscular wall of the uterus. The disease can cause severe menstrual bleeding, chronic pelvic pain and fertility challenges.
Despite affecting roughly one in three women, adenomyosis remains under-researched and underdiagnosed.
“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.”
In the review, Kho creates a practical roadmap for OB-GYN physicians. The article examines the biological mechanisms behind the disease, advances in diagnostic technology, and a range of modern treatment options.
A key advancement discussed in the review is the shift toward diagnosing adenomyosis without surgery.
For decades, the condition was often confirmed only after a hysterectomy, meaning physicians could only definitively diagnose it after removing the uterus.
Today, advances in imaging technology, such as ultrasound and MRI, allow physicians to identify the disease earlier and non-invasively.
“Our paradigm for diagnosing it 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.
Alongside diagnostic advances, Kho’s review also challenges the outdated assumption that hysterectomy is the only effective treatment.
“There are many excellent uterine-preserving options,” Kho explained. “Medical, interventional and surgical treatments can manage symptoms while preserving uterine function and future fertility.”
Given that no universally accepted treatment guidelines currently exist for adenomyosis, Kho hopes her work will help fill that gap for physicians caring for patients around the world.
“One in three women may have this condition,” she said. “Yet there are still no widely accepted standards of care. My hope is that this article helps begin to fill that void by providing guidance on first recognition and diagnosis, and ultimately selection of treatments that align with patients goals for care.”
While the publication will influence physicians globally, its impact is also being felt locally. Kho joined JABSOM to expand advanced gynecologic care in Hawaiʻi, expanding access to specialized and innovative treatment options for complex benign gynecologic conditions.