Adenomyosis

If endometriosis doesn’t get the attention it deserves, then adenomyosis (or “adeno” for short) might just be its even lesser-known cousin. Affecting 20% to 35% of women, it’s an all too common condition that's just as commonly missed or misdiagnosed.

What is adenomyosis?

Adenomyosis is a condition that occurs when the tissue that usually lines the uterus (endometrial tissue) invades the muscular wall of the uterus. Unlike endometriosis, where this tissue grows outside the uterus, adenomyosis stays within but causes its own set of challenges.

The misplaced tissue behaves as it normally would during your cycle—thickening, breaking down, and bleeding. But because it's trapped in the muscle, this can lead to intense pain, heavy periods, and an enlarged uterus.

While adenomyosis and endometriosis sound similar, and women with adenomyosis often have both, they’re different conditions. Adenomyosis is more about the tissue infiltrating the uterus wall, while endometriosis involves tissue growing outside the uterus entirely.

Despite its similarities to endometriosis, adenomyosis tends to fly under the radar, making diagnosis and treatment even more tricky.—but 

Adenomyosis symptoms​

Adenomyosis of the uterus can cause a range of symptoms, some of which are similar to other gynecological conditions. Here are some of the most common ones:

• Dysmenorrhea (painful periods): This is the most common symptom of adenomyosis, with studies suggesting that more than 80% of women with the condition experience significant period pain. 
• Chronic pelvic pain: Many women with adenomyosis experience ongoing pelvic discomfort, which can worsen during their period.
• Dyspareunia (painful sex): Pain during sex is a common issue for women with adenomyosis.
• Heavy menstrual bleeding: Most women with adenomyosis find that their periods are also much heavier than usual, with about 75% experiencing this symptom.
• Abdominal distension or bloating: The thickening of the uterine wall can cause a swollen, bloated feeling in the abdomen.
• Infertility issues: Although not as common, some women with adenomyosis may face challenges with fertility.
• Anemia: Due to heavy menstrual bleeding, anemia can develop, leading to fatigue and other related symptoms.

How do I know if I have adenomyosis?

Adenomyosis is sometimes referred to as a "silent disease" because despite its many symptoms, many people go years without realising they have it. Some women don't show any obvious signs, while others are stuck thinking painful periods are just “part of being a woman.” 

It’s all too easy for adenomyosis to be brushed off or misdiagnosed, with patients often being told their pain is “normal” or mistaken for other issues like fibroids or endometriosis. If something doesn’t feel right or your pelvic or period pain goes beyond what’s typical, don’t let it slide. You deserve to know what's really going on with your body.

Adenomyosis diagnosis

Diagnosing adenomyosis can be tricky since its symptoms can overlap with conditions like endometriosis, fibroids, and period pain. To get an accurate diagnosis, doctors typically rely on a combination of your symptoms, physical exams, and imaging tests.

• Medical history and symptoms: Your doctor will start by asking about your symptoms, like pain, heavy bleeding, and any past menstrual issues. They'll also ask about related symptoms such as pelvic discomfort or bloating to help build a clearer picture of what's going on.
  
  
• Physical exam: During a pelvic exam, your doctor may check for an enlarged or tender uterus. This is common with adenomyosis, as the tissue growing into the uterine muscle can make the uterus feel bigger or more sensitive.
  
  The physical exam can be external (feeling outside of the vagina) or internal, where the doctor may feel for an enlarged or tender uterus. Remember that you have the right to ask questions, request clarification, and decide what feels right for you—always advocate for your own comfort and health. Your body, your choice.
  
  
• Imaging tests: The best way to diagnose adenomyosis is through imaging, such as:
  
  
• Ultrasound: This test uses sound waves to create an image of your uterus and can sometimes show changes in the uterus' structure caused by adenomyosis.
  
  

• MRI (Magnetic Resonance Imaging): MRI provides a more detailed image and can help doctors get a clearer picture of the uterus, especially if your symptoms are more severe or if there are other conditions, like fibroids, to consider.
  
  
• Biopsy (uncommon): In some cases, a biopsy may be recommended, where a small tissue sample from the uterus is taken for analysis. However, this is less common since imaging tests usually provide enough information for a diagnosis.

What causes adenomyosis?

Anyone can develop adenomyosis, but some risk factors may make it a little more likely. Understanding these can help you assess your risk, but remember—having one or more of these factors doesn’t mean it's a sure thing. 

• Other uterine conditions: Adenomyosis rarely appears by itself—it often appears alongside fibroids and endometriosis, creating a perfect storm of pelvic problems.
  
  Studies suggest that fibroids (or leiomyomas) and adenomyosis can coexist in the same uterus in up to 57% of cases. What’s worse, women dealing with both conditions are more likely to experience pelvic pain, and report more severe symptoms like painful periods (dysmenorrhea), pain during sex (dyspareunia), and non-cyclic pelvic pain compared to women with fibroids alone.
  
  Adenomyosis and endometriosis are also found together frequently, though it’s hard for doctors to pinpoint exactly how often. Studies suggest that anywhere between 20% to 80% of women with endometriosis also have adenomyosis.
  
  
• Age: Adenomyosis is most commonly diagnosed in women between the ages of 35 and 50, particularly those who have gone through or are nearing menopause. This is likely due to hormonal changes that happen as women age.
  
  
• Childbirth history: Women who have had children are more likely to develop adenomyosis. The exact reason isn’t fully understood, but some believe that the process of childbirth (especially vaginal delivery) may cause changes in the uterus that make it more vulnerable to adenomyosis later in life.
  
  
• Hormonal factors: Since adenomyosis is influenced by hormones, especially oestrogen (a hormone involved in regulating the menstrual cycle), women with high levels of oestrogen may have a higher risk. This is why adenomyosis is often seen in women who have had many years of periods or have conditions that affect hormone levels.
  
  
• Previous uterine surgery: If you’ve had any surgery on your uterus, such as a C-section or a fibroid removal, you may be at a higher risk of developing adenomyosis. These procedures can cause scarring or changes to the uterine lining, which might contribute to the condition.
  
  
• Genetics:There’s some suggestion that adenomyosis may run in families, but the evidence is still unclear. It’s thought to be a condition influenced by various factors rather than strictly genetic.

Adenomyosis treatment

Treating adenomyosis isn’t a one-size-fits-all situation, but the good news is, there are plenty of options to help manage the symptoms. While hysterectomy is the only guaranteed cure, many other treatments can make a world of difference.

Here's how adenomyosis is typically treated:

1. Adenomyosis medication

• Pain relievers (NSAIDs): ibuprofen can take the edge off pain and inflammation.
• Hormonal treatments: Birth control pills, hormonal IUDs (like Mirena), or progesterone treatments can help balance your cycle and ease both the bleeding and pain.
• GnRH agonists: These temporarily hit the "pause" button on menstruation by lowering oestrogen, giving some relief from heavy periods and cramping.
• Tranexamic acid: These can be a helpful option for reducing heavy bleeding during your period.

2. Minimally Invasive Procedures

• Endometrial ablation: This procedure removes the lining of your uterus, reducing heavy periods. It’s not a cure, though, and isn’t recommended if you're planning on having children.
• Uterine artery embolisation (UAE): This technique cuts off blood flow to the adenomyosis-affected areas, helping shrink them and reduce symptoms.

3. Hysterectomy for adenomyosis

• Hysterectomy (removal of the uterus): This is the only definitive cure for adenomyosis — but is usually the last resort, especially if you’re not ready to part with your uterus.

4. Lifestyle Changes

• Dietary modifications: Adopting an anti-inflammatory diet, packed with whole foods can help calm some adenomyosis symptoms. Cutting back on caffeine, sugar, and processed foods might also help with bloating and fatigue.
• Exercise: Regular physical activity can do wonders for reducing pain and boosting your mood (endorphins can have a bigger impact than you might think).

5. Alternative Treatments

• Acupuncture: Acupuncture is commonly reported as a helpful treatment for managing adenomyosis symptoms, with some patients claiming significant relief. However, scientific evidence supporting its effectiveness is limited.
• Herbal supplements: Turmeric, ginger, and evening primrose oil are known for their anti-inflammatory powers. Just be sure to check with your doctor before exploring herbal remedies.

At Hazel, we provide comprehensive adenomyosis care tailored to your unique situation. Our women’s health doctors are dedicated to helping you find a personalised treatment plan that works best for you and your symptoms. Whether you're seeking advice, support, or treatment options, we're here to guide you every step of the way.

Adenomyosis and fertility

Adenomyosis can affect fertility, but the good news is not every woman with the condition will face challenges getting pregnant.

The impact on fertility can vary depending on how severe the adenomyosis is and other individual health factors. Some women may not experience any issues, while others might need additional support.

Does adenomyosis affect fertility?

Adenomyosis can make it harder to get pregnant for a few reasons: it can distort the uterus, making it harder for an embryo to implant and hormonal imbalances, especially involving estrogen, can affect ovulation.

The condition also causes inflammation in the uterus, which can impact egg quality and the function of the fallopian tubes and ovaries. Plus, adenomyosis is sometimes linked to fibroids, which can block tubes or alter the shape of the uterus, further complicating fertility.

Can you get pregnant with adenomyosis?

Yes, many women with adenomyosis can still get pregnant, though it might take a little longer or require extra support. The likelihood of pregnancy depends on the severity of adenomyosis, your age, and any other health factors.

If you’re finding it difficult to conceive, a fertility specialist can help create a plan tailored to your needs, helping you navigate both adenomyosis and your overall reproductive health with the best approach.

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Adenomyosis in a nutshell

Adenomyosis can be a challenging condition to live with, but with the right treatment and support, it's absolutely manageable. While the journey to diagnosis can sometimes be long and frustrating, once you understand what's going on, you and your healthcare provider can create a plan that works for you.

Whether it’s through medications, lifestyle changes, or even surgical options, there are many ways to reduce the pain and discomfort that come with adenomyosis. It’s all about finding the right combination of treatments that fit your life, needs, and goals.

And remember, you're not alone—many women are dealing with adenomyosis and finding ways to feel better despite the challenges. Our Hazel team is here to support you in finding a diagnosis and managing the symptoms.

Adenomyosis FAQ

Adenomyosis vs. Endometriosis: What’s the Difference?

Adenomyosis and endometriosis are often confused because both involve the lining of the uterus, but they affect the body in different ways — one is an unwanted houseguest, the other is a wanderer.

Adenomyosis occurs when the endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus. Endometriosis, however, happens when similar tissue grows outside the uterus—on the ovaries, fallopian tubes, or other areas of the pelvis. 

What is Adenomyosis belly?

Adenomyosis belly”—yep, it’s a thing. As the condition causes the tissue inside the uterus to grow into the muscle, the uterus may enlarge, which can lead to an abdominal feeling of fullness or puffiness, especially around your period. This can make your stomach look a bit swollen, almost like you’re a few months pregnant​. Fortunately, adenomyosis belly isn't dangerous in itself and various treatments can help manage symptoms.

What does a thickened uterine lining mean?

Been told you have a thickened uterus but not sure what that means? A thickened uterus is when the lining inside becomes thicker than usual, often due to hormonal changes, adenomyosis, or fibroids. In adenomyosis, the lining grows into the uterine muscle, leading to both thickening and uterine enlargement. While this isn't always a serious issue, it may cause symptoms like heavy bleeding or pain.

Should I be worried about an enlarged uterus?

An enlarged uterus can happen with conditions like adenomyosis or fibroids. While it's not always a cause for concern, it can lead to discomfort, heavy bleeding, or pelvic pain. If you're experiencing these symptoms or notice changes in your body, it's a good idea to check in with your doctor. They can run tests like ultrasounds to understand what's going on and guide you to the best treatment options. Worried about your symptoms? Don't hesitate to reach out to our doctors at Hazel—your health matters.

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