Transvaginal ultrasound is reported to be as sensitive (89%) and specific (89%) as MRI in diagnosis of uterine adenomyosis.

The most common ultrasound features of adenomyosis include asymmetrical myometrial thickening, transitional zone thickening >12 mm, heterogeneous myometrial echopattern, myometrial echogenic linear or nodular striations (specific sign) and associated increased blood flow, as well as the "venetian blind" pattern of acoustic shadowing.