The rapid advancements in volume rendering of ultrasound data over the past decades, particularly three-dimensional (3D) ultrasound techniques, have created new opportunities for refining the diagnosis of adenomyosis. Today, the diagnosis of adenomyosis no longer relies on histology but on non-invasive diagnostic tools such as two-dimensional (2D) and 3D ultrasound and magnetic resonance imaging (MRI). The 3D view offers significant advantages, including better evaluation of the junctional zone (JZ) in different planes and the ability to navigate within the uterine volume, allowing for more accurate classification of adenomyosis across different myometrial layers. Four-dimensional transvaginal sonography (4D TVS) is currently more commonly used in dynamic hysterosalpingo-contrast sonography (HyCoSy). It appears that 4D HyCoSy can evaluate intravasation in real-time 3D view more accurately than 2D TVS, particularly in cases of endometrial/myometrial pathologies such as JZ adenomyosis. The dynamic nature of 4D TVS is expected to enhance future evaluations of uterine contractility, which is often altered in adenomyotic uteri. Several studies have focused on the non-invasive diagnosis of adenomyosis and its association with symptoms and infertility. The 2D and 3D TVS approaches are crucial for accurately and promptly diagnosing adenomyosis, a condition that affects women of reproductive age. Although 4D TVS currently adds less value to the diagnosis of adenomyosis, it is anticipated to provide more precise insights into uterine contractility and endometrium/myometrium permeability in this disease in the future.