Adenomyosis vs Endometriosis: Sisters, not Twins

Meet adenomyosis and endometriosis, often associated with each other, and for good reason. 

Affecting approximately 200 million women and people assigned female at birth (AFAB) worldwide, both conditions are notorious for being the leading culprits behind intense period pain, affecting the uterus and its functions, and being incredibly misunderstood and underdiagnosed. 

But while adenomyosis and endometriosis share similarities, these two conditions actually behave very differently, affecting different areas of the body, and requiring different approaches to reach a diagnosis and treatment. 

Ready to explore exactly what sets these two conditions apart? Let’s get started. 

Adenomyosis vs Endometriosis: what’s the difference? 

So we know that adenomyosis and endometriosis sound similar, and they both make periods way more difficult than they need to be, but how do they differ from one another? 

Where they’re found 

One key point of difference is where the excessive tissue growth actually ends up. 

Adenomyosis occurs when tissue that would normally line the uterus grows into the muscular wall of the uterus, also known as the myometrium. This can result in serious cramping, heavy periods, and pelvic pain. 

On the other hand, affecting up to 10% of women of reproductive age, endometriosis occurs when endometrial-like tissue begins to grow outside of the uterus. This tissue can be found on the ovaries, fallopian tubes, and unexpected places like the bowels. Ever heard that endometriosis is a full-body disease? That’s because it doesn’t just affect the pelvic area – endo can wreak havoc on other parts of the body, causing damage to the lining of the lungs, the heart, and even the nervous system. 

Unlike normal uterine lining that sheds during your menstrual cycle, this tissue is trapped with nowhere to go, causing inflammation, scarring, and seriously crippling pain. 

Who they affect

While studies show that endometriosis often begins in early adolescence, adenomyosis is more common in individuals over 35, particularly those who have had children. However, recent research has shown that as awareness increases, adenomyosis has been found in younger cases in women between the ages of 18–35. 

Symptoms of Adenomyosis and Endometriosis  

If you’ve ever had your period pain brushed off and excused as a normal part of life, know that you’re not alone. But the truth is, period pain that disrupts your routine and impacts your day-to-day is far from a normal part of life. 

While period pain is one of the most common symptoms of both conditions, adenomyosis, and endometriosis can come with a whole host of symptoms that are so much more than just period pain. 

Adenomyosis Symptoms 

Some of the most common symptoms of adenomyosis include: 

• Heavy, painful periods: we’re talking about changing your tampons, pads, or menstrual cups more frequently than usual
• Pain before, during, and after your period: think deep, lasting pain that starts before your period arrives and lasts long after your menstrual cycle is over
• Pain during sex (aka dyspareunia)
• Adenomyosis belly (or adeno belly) as a result of an enlarged uterus

Endometriosis Symptoms

Studies have shown that some of the most common signs and symptoms of endometriosis typically include: 

• Severe pelvic pain that can flare up at any time – not just during menstruation
• Dyspareunia, or pain during sex
• Pain during urination or with bowel movement as a result of misplaced endometrial tissue growing on the bladder and bowels 
• Chronic fatigue 
• Infertility or  difficulties conceiving 

Both adenomyosis and endometriosis can cause painful, heavy periods and a few other similar symptoms…enter missed diagnoses and misdiagnoses. 

If you’re familiar with any of the above symptoms, we recommend digging deeper and finding a doctor who hears you and takes you and your symptoms seriously. 

Getting the correct diagnosis is the first step to reclaiming your life and starting to feel better. 

How is adenomyosis diagnosed? 

If you suspect you might be suffering from adeno, your journey to receiving a diagnosis may feel like a long and frustrating one – especially since its symptoms are often brushed off as “just heavy periods”. 

But the good news is, with the support of the right doctor and care team, receiving a diagnosis is possible. Here’s how adenomyosis is typically diagnosed: 

Step 1: Discussing your symptoms with your doctor 

A supportive women’s health doctor, like one of our Hazel experts, will begin by getting to know you and your menstrual cycle in a bit more detail. You might be asked questions on your period history, pain levels, and any other symptoms you might regularly experience – such as bloating, heavy periods, or pain during sex. 

Since adeno shares common symptoms with endo, it’s important to share as much detail as possible with your doctor. 

Step 2: Pelvic exam 

When conducting your pelvic exam, your doctor may perform both an external and internal exam to check for an enlarged or tender uterus. An enlarged uterus not only leads to what’s often referred to as “adenomyosis belly”, but it also helps your doctor guide the diagnosis of adenomyosis. 

And always remember: your body, your choice. If you’re uncomfortable with the idea of an internal pelvic exam, you have the right to advocate for yourself and say no. It’s OK to speak openly with your doctor about your preferences and concerns (in fact, we encourage it!) – your care team are there to help ensure you feel comfortable and informed throughout every step of the way. 

Step 3: Ultrasound and other imagery tests 

While a simple blood test won’t confirm an adenomyosis diagnosis, thankfully, an ultrasound or MRI can help doctors identify the presence of it. An ultrasound may show thickened or enlarged uterine walls, while an MRI can give an in-depth look at the muscle of the uterus, and any changes in its structure. 

Step 4: Confirming a diagnosis and ruling out other conditions 

Because adenomyosis has symptoms that overlap with endometriosis and other female reproductive health conditions, your doctor may first choose to rule out the presence of any other conditions before landing on an adenomyosis diagnosis.

While in the past the only way to confirm a diagnosis of adenomyosis was through a biopsy of the uterine muscle or a hysterectomy, studies have shown that ultrasound and MRI imaging can provide enough evidence that doctors can diagnose adenomyosis without requiring surgery. 

If your symptoms are seriously impacting your daily life, do. not. brush. them. off. Track all your symptoms, advocate for yourself at your appointments, and if you feel dismissed by any of your doctors or care providers, don’t hesitate to get a second opinion. 

Your pain is real and valid, and you deserve answers. 

How is endometriosis diagnosed? 

Whether you’re an endo-haver or not, if there’s one thing everyone knows about this condition, it’s just how difficult it is to receive a diagnosis. 

This is partly because its symptoms can mimic that of other conditions (adenomyosis, IBS, pelvic pain, pelvic inflammatory disease – we’re looking at you!), and partly because too many women have been told for too many years that period pain is just something we as females have to deal with. And spoiler, it’s not. 

While it still takes an average of almost 7 years to receive an endo diagnosis, here’s exactly what’s involved in doctors helping you land a diagnosis: 

Step 1: Discussing your medical history and symptoms with your doctor 

The first step is to take your doctor on a deep dive into your symptoms. Your doctor may ask you to share details about the severity and frequency of your pain, your menstrual flow, any family history of the condition, and any digestive issues you may regularly experience (think bloating, diarrhoea, and constipation). 

Step 2: Pelvic exam 

Similar to a pelvic exam conducted when diagnosing adeno, your doctor may choose to perform an external and internal exam to check for any abnormalities, thickened areas, or tenderness that could indicate endometriosis.

If you’re not comfortable with an internal pelvic exam, remember you have the right to advocate for yourself and speak up about your medical preferences and wishes. 

It’s important to note that a pelvic exam does not lead a doctor to provide you with a definitive diagnosis of endometriosis – picture it more like a piece of the puzzle helping to form the full picture of your diagnosis. 

Step 3: Ultrasound imaging

An ultrasound is another example of a tool that can be used to help doctors to identify the growth of misplaced endometrial tissue. 

The three types of ultrasound your doctor may use to help them detect the presence of endometriosis include: 

1. Transabdominal ultrasound 
2. Transvaginal ultrasound
3. Transrectal ultrasound 

While ultrasounds are easily accessible, non-invasive, and provide doctors with immediate results and imaging, as a result of the quality of ultrasound imagery, they aren’t always able to detect endometriosis in the following cases: 

• Where scar tissue and adhesions are found deep in the pelvic structure 
• Organs that have been deeply infiltrated by endometriosis 
• Small lesions 

P.S., we talk all things ultrasounds and endo (in even more detail) in this article. 

Step 4: Laparoscopic surgery 

‍Laparoscopic surgery involves the insertion of a small camera into the abdomen to find (and sometimes remove) endometriosis tissue. If lesions are found during the laparoscopy, a biopsy can be taken to confirm the diagnosis. 

While surgery is still seen as the only way to definitively diagnose endometriosis, if surgery isn’t on your bingo card (and we’ll never shame you for having preferences in the treatment you receive), we recommend getting a second opinion from a doctor who can explain all of your options to you in detail. 

If healthcare professionals are shrugging off your symptoms, trust yourself and your experience. If you feel safe to do so, push for further testing, or seek out a second opinion from a more supportive specialist – like one of our Hazel experts. 

Remember, you know your body better than anyone and period pain that disrupts your life is always worth investigating. 

Treatment for adenomyosis and endometriosis 

While there’s no permanent cure (just yet) for adenomyosis or endometriosis, there are a range of treatment options out there that can help you manage your symptoms, reduce your pain, and seriously improve your quality of life. 

The right approach to treatment depends on your goals, your symptoms, and how your body responds to treatment. 

Adenomyosis treatment 

Treatment options for adenomyosis include: 

• Pain relief: while over-the-counter painkillers do a great job of masking the pain, it’s important to note that they don’t address the underlying issues. 
• Hormonal Treatments: the Pill (aka Hormonal Birth Control) or the Hormonal IUD can help to reduce pain and significantly lighten periods by thinning the uterine lining. 
• GnRH agonists: also known as gonadotropin-releasing hormones, these medications can reduce oestrogen levels (which we now know fuel adenomyosis!) and can shrink the presence of adenomyosis in some patients. Before commencing treatment, it’s important to note that these medications can also have significant side effects, such as temporary menopause, hot flashes, and bone loss.
• Natural medicine: with studies demonstrating that medicinal cannabis can be used to help manage chronic pelvic pain, some individuals living with adenomyosis may find significant relief from their symptoms through the use of this natural medicine..

Endometriosis treatment 

Treatment options for endometriosis include: 

• Pain relief: NSAIDs (such as ibuprofen) can help to reduce inflammation and severe pelvic pain in some cases 
• Hormonal therapies and hormonal birth control: the Pill, IUD, and GnRH agonists can suppress the growth of endometriosis and ease symptoms. 
• Laparoscopic surgery: both used in the diagnosis and treatment of endometriosis, laparoscopic surgery involves surgically removing the endometrial tissue to provide long-term relief. If you choose to go down this route, it’s important to note that a laparoscopy doesn’t prevent the tissue from growing back. 
• Lifestyle changes: eating an anti-inflammatory diet, pelvic physiotherapy, yoga, meditation and acupuncture have been shown to reduce inflammation, stress and symptoms associated with endometriosis, 
• Natural medicine: studies have shown that natural medicines such as medicinal cannabis can ease chronic pain and gastrointestinal issues in some patients with endometriosis. 

We don’t believe in one-size-fits-all approaches to treatment, and you shouldn’t either; because what works for one person may not necessarily work for you, or the next person. 

The key to accessing the right treatment for you is to find a doctor who listens and offers you a personalised approach to treatment, based on your individual symptoms, lifestyle, and goals – like our Hazel Women’s Health Doctors. 

If your current treatment plan isn’t working, don’t be afraid to explore your other options, or get a second opinion. We know that managing adenomyosis and endometriosis is a journey, but it’s one you don’t have to go through alone. 

Causes of adenomyosis and endometriosis  

Curious as to why exactly adenomyosis and endometriosis happen? You’ve come to the right place. 

What causes adenomyosis? 

Often linked to inflammation and hormonal changes, studies have shown that the most common causes of adenomyosis include: 

• Hormones: studies have found that oestrogen plays a key role in adenomyosis, which is why symptoms are likely to improve when oestrogen levels begin to drop in perimenopause and menopause.
• Inflammation: chronic inflammation in the uterus has been shown to encourage the growth of misplaced tissue. 
• Past surgeries: surgeries such as c-sections, the removal of fibroids, and even a D&C can trigger adenomyosis by creating pathways for endometrial tissues to invade the muscle of the uterus.
• Genetics: those with a family history of adenomyosis are more likely to develop the condition. 

What causes endometriosis? 

Some of the main causes of this condition are linked to: 

• Genetics: much like adenomyosis, those with a family history of endometriosis are more likely to develop the condition themselves. 
• Retrograde menstruation: occurring when menstrual blood containing endometrial cells flows back and through the fallopian tubes into the pelvis, instead of exiting the body via the vagina.
• Immune system: our immune systems are typically pretty good at attacking and clearing things that shouldn’t be there. However, some studies have shown that in people with endo, their immune systems may struggle to recognise this misplaced tissue. 

Are adenomyosis and endometriosis linked?  

Yes and no. 

While they are separate conditions, adenomyosis and endometriosis can still be linked… in the sense that it is possible to have both conditions at the same time. Yep, unfair, we know. Because both endo and adeno involve misplaced tissue growth, painful periods, and inflammation, when they show up together, it can make getting an accurate diagnosis and appropriate treatment even trickier. 

When in doubt (or when your current healthcare provider seems dismissive of your symptoms and experience), we recommend reaching out to an expert who specialises in conditions like endometriosis and adenomyosis, like a Hazel Women’s Health Doctor.

With the right support and guidance, you can receive the diagnosis and treatment options you’ve been waiting for.  

Adenomyosis vs Endometriosis: The Wrap-Up 

Repeat after us: while adenomyosis and endometriosis share similarities, they aren’t the same. 

Yes, they have intense pelvic pain, heavy periods, and an overgrowth of endometrial tissue in common, but these two distinct conditions require different approaches to reach a correct diagnosis and appropriate treatment. The road to receiving a diagnosis can feel like a never-ending one, but it’s essential for helping you manage your symptoms – whether that be pain management, hormonal treatment, surgery, or lifestyle changes. 

Most importantly, know that your pain is real, your experience is valid, and you deserve care that helps you feel like you again. If something feels off in your body, trust yourself. Keep pushing for answers, explore different treatment options, and surround yourself with professionals (and other people) who listen to you. 

With Hazel’s team of experts who specialise in reproductive conditions like endometriosis and adenomyosis, you can access care that’s completely tailored to you and your needs – on your terms. Remember, you aren’t on this journey alone.