Written by Dr. Specialist Stine Andreasen
Specialist in Gynecology and Obstetrics, PhD in Obstetrics in 2015 and more than 15 years of clinical practice in Obstetrics and Gynecology
Adenomyosis is a benign condition in which tissue similar to the lining of the uterus (endometrium) grows into the muscular wall of the uterus (myometrium). It can cause heavy periods, painful periods and chronic pelvic pain, but some women have no symptoms at all.
Key takeaways
- Adenomyosis is benign and most common in women in their 30s and 40s, although younger women can also be affected.
- The most common symptoms are heavy periods, painful periods and pelvic pain.
- It can usually be diagnosed with transvaginal ultrasound, without surgery.
- TMany women get substantial relief without surgery, and a hormonal IUD is often one of the preferred treatments.
- Many women with adenomyosis get pregnant naturally, although the condition has been linked to reduced fertility in some studies.
- Symptoms often improve after menopause.
What is adenomyosis?
In adenomyosis, endometrial-like tissue grows into the muscular wall of the uterus. This can make the uterus enlarged and tender, and may lead to heavy menstrual bleeding, painful periods and chronic pelvic pain. It is a relatively common condition, particularly among women in their 30s and 40s, although it can also affect younger women.
What causes adenomyosis?
The exact cause of adenomyosis is not fully understood. It is believed to develop when tissue resembling the uterine lining (endometrium) grows into the muscular wall of the uterus (myometrium). Several factors may contribute, including hormonal influences, inflammation, and changes in the boundary between the endometrium and myometrium. Estrogen plays an important role, and symptoms often improve after menopause.
What are the symptoms of adenomyosis?
Symptoms vary a lot. Some women have mild symptoms, while others have substantial discomfort that affects daily life and quality of life. Common symptoms include:
Heavy or prolonged periods. This is one of the most common symptoms.
Severe period pain, often described as deep, aching or pressure-like pain in the lower abdomen. Some women notice their periods becoming more painful over time.
Pelvic pain outside of periods, such as persistent discomfort, heaviness or pressure in the lower abdomen.
Deep pain during sex (dyspareunia), particularly with extensive adenomyosis or when endometriosis is also present.
Fertility problems in some women. → See Can you get pregnant with adenomyosis? below.
How is adenomyosis diagnosed?
Diagnosis is usually based on your symptoms, a gynecological examination and imaging. During a pelvic examination, the uterus may feel enlarged, rounded or tender.
Ultrasound
Transvaginal ultrasound is generally the first imaging method used when adenomyosis is suspected. Typical findings may include:
An enlarged or rounded (globular) uterus
Uneven thickening of the uterine muscle
Small cysts within the uterine muscle
Changes in the junctional zone, the border between the uterine lining and the muscle
Irregular, fan-shaped shadowing within the uterine wall
Adenomyosis may be diffuse, affecting larger areas of the uterine muscle, or focal, affecting a more limited area.
MRI
MRI may be useful when the ultrasound findings are unclear, when other uterine conditions are suspected, or when more detailed information is needed before treatment. It isn’t routinely needed for everyone.
Adenomyosis vs endometriosis: what’s the difference?
The two conditions are related but distinct:
Adenomyosis: endometrial-like tissue is found within the muscular wall of the uterus.
Endometriosis: endometrial-like tissue is found outside the uterus, commonly on the ovaries, the lining of the pelvis or surrounding structures.
Both can cause painful periods, chronic pelvic pain and fertility problems, and they can occur together. Heavy bleeding and an enlarged uterus are more typical of adenomyosis, but symptoms alone can’t reliably tell the two apart.
Read more → Endometriosis
How is adenomyosis treated?
Treatment depends on how severe your symptoms are, your age, whether you want to get pregnant, and your personal preferences. Not everyone needs treatment, and with mild symptoms, monitoring and symptom relief may be enough.
Pain relief and non-hormonal treatment
Anti-inflammatory painkillers (NSAIDs) such as ibuprofen or naproxen may help relieve period pain.
Tranexamic acid is a non-hormonal medicine that can reduce menstrual blood loss. It is taken on heavy bleeding days and may suit women who prefer to avoid hormones.
Hormonal treatment
Hormonal IUD: A levonorgestrel-releasing IUD is often one of the preferred treatments for women who don’t currently want to get pregnant. It releases a small amount of progestogen directly into the uterus. It can reduce bleeding, improve period pain and provide effective contraception.
Combined hormonal contraception: The pill, vaginal ring or patch may help regulate bleeding and reduce period pain. Continuous use, without regular hormone-free breaks, can be particularly helpful for severe symptoms.
Progestogen-only treatment: Progestogen tablets and, in selected cases, other progestogen-based contraceptive methods may also reduce symptoms.
GnRH agonists and antagonists: For severe symptoms that don’t respond to standard hormonal treatment, medicines that suppress the ovaries’ hormone production may be considered. By lowering estrogen levels, they may improve pain, reduce bleeding and temporarily shrink the uterus.
Read more → Contraception methods
Surgery and other procedures
Surgery may be considered when symptoms are severe, medical treatment hasn’t worked, or you want a definitive solution.
Hysterectomy: Removing the uterus is the only definitive treatment for adenomyosis. It may be appropriate for women with severe symptoms who have completed their families and haven’t had enough relief from other treatments. The ovaries usually don’t need to be removed because of adenomyosis alone.
Adenomyomectomy or uterine artery embolization: In selected cases, removing focal adenomyosis or blocking the blood supply to the affected area may be considered.
Endometrial ablation: This destroys the lining of the uterus to reduce bleeding. It may help bleeding in some women, but it doesn’t remove adenomyosis within the muscle. Treatment failure or ongoing pain may be more likely, especially with deeper adenomyosis.
Can you get pregnant with adenomyosis?
Yes. A diagnosis of adenomyosis doesn’t mean pregnancy is impossible, and many women with adenomyosis get pregnant naturally and have uncomplicated pregnancies.
However, adenomyosis may affect the environment in the uterus. In some studies, it has been linked to lower implantation rates and a higher risk of miscarriage and certain pregnancy complications, particularly among women having fertility treatment.
Hormonal treatments can control symptoms, but they generally prevent or delay pregnancy while you’re using them.
Does adenomyosis go away after menopause?
For many women, symptoms improve after menopause, as estrogen levels fall and periods stop. Symptoms don’t necessarily disappear right away, though, and persistent pelvic pain or new bleeding after menopause should always be checked.
When should you see a doctor?
Contact a healthcare professional if you have:
Periods so heavy they significantly affect daily life
Severe or worsening period pain
Persistent pelvic pain or pressure
Pain during sex
Signs of anemia, such as marked tiredness or dizziness
Difficulty getting pregnant
Bleeding between periods or after menopause
This article is general information and not a substitute for medical advice. Talk to your doctor about whether hormone therapy is right for you.
FAQ – Contraception
-
Adenomyosis is a benign condition, but symptoms such as heavy bleeding and pain can significantly affect quality of life. Effective treatments are available.
-
Yes. Transvaginal ultrasound is usually the first imaging method used, and many women can be diagnosed without surgery.
-
Yes. Pain relief, tranexamic acid, a hormonal IUD and other hormonal treatments can give substantial relief for many women.
-
A hormonal IUD is often one of the preferred treatments. It can reduce bleeding and period pain while providing contraception.
-
Hysterectomy is the only definitive treatment, but many women get enough relief without surgery.