Adenomyosis, also known as adenomyosis uteri, is a condition in which tissue similar to the endometrium (the lining of the uterus) grows into the muscular wall of the uterus, called the myometrium. The misplaced endometrial tissue continues to respond to hormonal changes during the menstrual cycle. As a result, the uterine muscle may become thickened and enlarged, which can lead to heavy menstrual bleeding, painful periods and pelvic discomfort. Adenomyosis is a benign (non-cancerous) condition. However, its symptoms can significantly affect a person’s daily activities, work, relationships and overall quality of life. Adenomyosis may occur by itself or alongside other conditions, such as uterine fibroids or endometriosis. Some people have adenomyosis without noticeable symptoms, while others experience significant menstrual pain or bleeding.
Symptoms can vary from person to person. Common symptoms include:
Heavy menstrual bleeding – Periods may be unusually heavy or require frequent changing of sanitary products.
Prolonged menstrual bleeding – Menstrual periods may last longer than usual.
Painful periods (dysmenorrhea)– Menstrual cramps may become severe or progressively worsen over time.
Pelvic pain – Aching or discomfort in the lower abdomen or pelvis may occur, particularly during menstruation.
Pain during sexual intercourse– Some people may experience deep pelvic pain during or after intercourse.
Spotting or bleeding between periods – Irregular bleeding may occur in some cases.
Enlarged or tender uterus – The uterus may become enlarged and feel tender during a pelvic examination.
Bloating or a feeling of fullness – Enlargement of the uterus may cause pressure or fullness in the lower abdomen.
Fatigue and weakness – Heavy or prolonged menstrual bleeding can sometimes lead to iron-deficiency anemia, causing tiredness, weakness or shortness of breath.
Symptoms may become more noticeable during the reproductive years and may improve after menopause as hormone levels decline.
The exact cause of adenomyosis is not known. Researchers have proposed several possible explanations, including the following:
Growth of endometrial tissue into the uterine muscle: Cells from the uterine lining may move into the muscular wall of the uterus.
Uterine injury or previous procedures: Previous childbirth, caesarean delivery or uterine surgery may be associated with the development of adenomyosis, although the exact relationship is not fully understood.
Developmental origin: In some people, endometrial tissue may become embedded in the uterine muscle during the development of the uterus.
Hormonal influence: Adenomyosis is influenced by reproductive hormones, particularly estrogen, which may contribute to the growth and activity of the misplaced tissue.
Having one or more possible risk factors does not necessarily mean that a person will develop adenomyosis.
A healthcare professional may begin with a detailed medical history and pelvic examination. The doctor may ask about menstrual bleeding, pain, previous pregnancies, childbirth and uterine procedures.
Tests may include:
An ultrasound can help identify changes in the uterine muscle that may suggest adenomyosis. It can also help distinguish adenomyosis from other causes of abnormal uterine bleeding, such as fibroids.
An MRI can provide more detailed images of the uterus and may be recommended when the diagnosis is uncertain or when additional information is needed for treatment planning.
Blood tests may be recommended when heavy menstrual bleeding is present. A complete blood count (CBC) and iron studies can help determine whether anemia or iron deficiency has developed. There is no single test that definitively diagnoses adenomyosis in every patient. A doctor considers symptoms, examination findings and imaging results together.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or other medicines recommended by a healthcare professional, may help reduce menstrual pain and inflammation.
Hormonal therapies may help control heavy bleeding and menstrual pain by reducing the effect of reproductive hormones on the uterine lining and adenomyosis. Depending on the individual situation, treatment may include:
Hormonal birth-control pills
Progestin-based treatments
Hormonal intrauterine devices (IUDs)
Other hormone-regulating medicines
A doctor should determine which hormonal treatment is appropriate.
For people with severe symptoms that do not improve with other treatments, surgical options may be considered. A hysterectomy, which involves removal of the uterus, is the definitive treatment for adenomyosis. It is generally considered when symptoms are severe and other treatments have not provided adequate relief, particularly when future pregnancy is not desired. Uterus-preserving procedures may be appropriate for selected patients, depending on the extent of the disease and their reproductive goals. A gynaecologist can discuss the potential benefits, limitations and risks of these options.
Adenomyosis may be associated with difficulties becoming pregnant in some individuals, although many people with adenomyosis can conceive.
The condition may also be associated with certain pregnancy complications. Anyone with adenomyosis who is trying to conceive or experiencing fertility problems should discuss their individual situation with a gynaecologist or fertility specialist.
Depending on the symptoms and treatment needs, the doctor may also recommend consultation with a fertility specialist or other appropriate healthcare professional.
No. Adenomyosis is generally a benign, non-cancerous condition. However, symptoms such as abnormal bleeding should be evaluated because they can have several possible causes.
No. Both conditions involve endometrial-type tissue, but they occur in different locations. In adenomyosis, the tissue grows within the muscular wall of the uterus. In endometriosis, endometrial-like tissue grows outside the uterus.
Adenomyosis usually does not simply disappear during the reproductive years. Symptoms often improve after menopause because reproductive hormone levels decline.
Adenomyosis may affect fertility in some people, but it does not mean that pregnancy is impossible. Fertility concerns should be discussed individually with a gynaecologist or fertility specialist.
Yes. Many people manage symptoms with pain-relieving medicines, hormonal treatments and treatment for anemia. The appropriate treatment depends on the individual’s symptoms and reproductive plans.
A hysterectomy is considered the definitive treatment because it removes the uterus. However, many non-surgical treatments can effectively control symptoms, and symptoms often improve after menopause.
Medical Disclaimer: This article is intended for general educational purposes and should not be considered a substitute for professional medical advice, diagnosis or treatment. If you have symptoms of adenomyosis or abnormal menstrual bleeding, consult a qualified healthcare professional for an appropriate evaluation.
