All About Adenomyosis

Adenomyosis can be a painful condition that occurs when your endometrial tissue grows into the muscular wall of the uterus. Although sometimes adenomyosis can have no signs or symptoms (just mild discomfort), it can cause heavy or prolonged menstrual bleeding, extreme cramping or sharp pain during menstruation, chronic pelvic pain and pain during intercourse. It is possible for the condition to be located throughout the entire uterus or localised in one spot.

Adenomyosis usually affects women between 40 and 50 years old. Doctors aren't exactly sure what causes adenomyosis, however approximately 80% of women with adenomyosis have a history of childbirth.

Conditions that may increase the risk of adenomyosis include:

• Middle age
• Childbirth
• Surgery on the uterus (caesarean delivery, dilation and curettage and fibroid removal surgery)
• Early age of the onset of the menstrual cycle
• Short menstrual cycle
• Hormonal imbalance
• Inflammation of the uterus

Is adenomyosis a serious condition?

“Although adenomyosis is considered a non-life-threatening condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman’s quality of life”.

What is the best treatment for adenomyosis?

The most effective cure for adenomyosis is the removal of the uterus (hysterectomy). Medications can also help control the symptoms of adenomyosis however, symptoms usually subside after menopause. This means that the treatment of adenomyosis depends on the severity of symptoms and how close the woman is to menopause.

Treatments include:

• Pain control medications (anti-inflammatory nonsteroidal drugs e.g. ibuprofen).
• Hormonal medications (birth control pills, intrauterine devices (IUD’s), hormone-containing patches and vaginal rings. Additionally, leuprolide – a medication that stops ovaries from producing estrogen and progesterone).
• Urine artery embolization – a surgical procedure which a small tube is inserted into the patient’s thigh, cutting off the blood supply to the adenomyosis shrinking the abnormal tissue which controls the symptoms.
• Endometrial ablation – a surgical procedure which destroys or scars the lining of the uterus.
• Hysterectomy – a surgical procedure to remove all or part of the uterus (procedure may take place as a last resort if other treatments have not been successful).

What happens if adenomyosis is left untreated?

In most cases of adenomyosis, patients will seek help.  However, infertility is a common result of adenomyosis. Patients that are considering pregnancy would benefit from an MRI scan to determine if the condition is present and where it is located on the uterus. An ultrasound may not be a sufficient enough option for an accurate diagnosis of adenomyosis. If you have symptoms of adenomyosis, talk to your doctor to organise an MRI for diagnosis.

Other complications of untreated adenomyosis include heavy bleeding or painful periods. Heavy bleeding can lead to anaemia and if severe, may require a blood transfusion. Strong pelvic pain or painful periods may negatively impact a woman’s quality of life.

What is the difference between endometriosis and adenomyosis?

Endometriosis and adenomyosis are both conditions of the endometrial tissue that lines the uterus. They are similar conditions however they develop differently and have some changes in symptoms.

With adenomyosis, endometrial-like cells grow into the muscular wall of the uterus. The misplaced cells follow the usual menstrual cycle and as the uterus wall thickens, it can cause heavy pain and bleeding. Adenomyosis usually affects older people.

With endometriosis, the endometrial-like cells grow outside the uterus instead of inside like adenomyosis. The tissue is usually found on the ovaries supporting ligaments of the uterus, and in the cavities of the pelvis. Endometriosis follows the menstrual cycle (bleeding monthly) however may cause pain. It usually affects adolescents and people of reproductive age.  

It is possible for patients to have one or both of these disorders. A study conducted in 2017 found that 300 women diagnosed with adenomyosis between 2008 and 2016 found that 42.3% also had endometriosis.

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Medical Disclaimer: Articles are intended for informational purposes only and should not be used as the basis of patient treatment. Ask a medical professional if you have any health-related questions or concerns.

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Additional resources

Allarakha, S. (2021). Is adenomyosis serious.https://www.medicinenet.com/is_adenomyosis_serious/article.htm

Byrd, F. (2020). What is adenomyosis. https://www.webmd.com/women/guide/adenomyosis-symptoms-causes-treatments

Health Direct. (2020). Adenomyosis. https://www.healthdirect.gov.au/adenomyosis

Mayo Clinic. (2020). Adenomyosis. https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138#:~:text=Adenomyosis%20(ad%2Duh%2Dno,bleeding%20%E2%80%94%20during%20each%20menstrual%20cycle.

Women’s Health Staff. (2021). Think you have adenomyosis? This might help.https://coolspringsobgyn.com/adenomyosis-the-silent-disease/

Hecht, M. (2021). Endometriosis vs. adenomyosis: similarities and differences.https://www.healthline.com/health/womens-health/adenomyosis-vs-endometriosis