Adenomyosis occurs when the tissue that normally lines the uterus (the endometrium) grows into the uterine muscle (myometrium). While it’s often compared to endometriosis, another disorder of endometrial tissue, the two conditions are different. The exact cause of adenomyosis is unknown, but there is a connection to estrogen since the disease resolves after menopause.
Endometriosis involves endometrium-like tissue outside the uterus (sometimes on ovaries or fallopian tubes), whereas adenomyosis is confined to the uterine wall. Like endometriosis, the misplaced tissue in adenomyosis responds to menstrual hormones—thickening and breaking down—causing inflammation and pain because the tissue cannot shed normally.
While many people are asymptomatic, others experience symptoms including heavy, painful periods, irregular bleeding, premenstrual pelvic pain, painful intercourse, and painful urination or bowel movements. Heavy bleeding can also lead to iron-deficiency anemia.
Who Is at Risk?
Adenomyosis most commonly appears in people in their 40s. Women at risk include those who have had previous uterine surgery such as a C-section, fibroid removal, or dilation and curettage, as well as those who have had childbirth or are in middle age.
Common Signs and Symptoms
- Enlarged uterus
- Painful periods
- Heavy and irregular bleeding
- Painful sex
- Infertility
It’s estimated that one-third of women don’t experience any symptoms from adenomyosis, while two-thirds do.
Associated Conditions and Causes
Adenomyosis can coexist with conditions like endometriosis and fibroids. While the exact cause is unknown, suspected contributors include hormone dependence, genetics, immune factors, and abnormal healing after uterine surgery.
Diagnosis Challenges
Diagnosis is challenging and frequently delayed because symptoms overlap with other disorders such as endometriosis, IBS, PID, and perimenopause. Additionally, diagnostic criteria are not standardized.
Transvaginal ultrasound identifies nearly half of cases, and MRI can help when ultrasound results are inconclusive.
Diagnosis is typically based on symptoms and imaging findings from pelvic ultrasound or magnetic resonance imaging (MRI). Since many women do not experience symptoms, adenomyosis is often underdiagnosed. Painful periods with heavy and irregular bleeding can also be seen in other medical conditions, making diagnosis more complex.
Many health experts still disagree on how to define and classify imaging and pathology related to adenomyosis.
Treatment Options for Adenomyosis
Treatment focuses on symptom relief rather than cure. Options include:
- Over-the-counter pain relievers
- Hormonal therapies such as progestin-only pills
- Levonorgestrel IUDs to thin the uterine lining
- Uterine artery embolization for symptom control
- Hysterectomy as a definitive option for those not seeking fertility
For those who want to conceive, treatment depends on the symptoms experienced.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) help with cramps and pelvic pain
- Birth control pills and progesterone IUDs help control heavy bleeding and cramps
If you have persistent symptoms and feel dissatisfied with your healthcare experience, advocate for yourself and discuss the possibility of adenomyosis with your provider.
Endometriosis Treatment Overview
The effectiveness of endometriosis treatment depends on how well the patient responds. Many individuals benefit from hormonal therapy (such as birth control pills or GnRH agonists) combined with pain relievers, while others require a combination of medical therapy and surgery.
Endometriosis is a chronic, long-term disease. The goal of treatment is to manage symptoms and slow disease progression.
Treatment decisions are influenced by:
- Severity of symptoms
- Impact on daily life
- Fertility goals
- Patient’s age
Pain medications are commonly used to manage symptoms but do not treat the disease itself. They are often used alongside hormonal therapy or surgery.
Hormonal therapy is typically the first line of treatment. It works by lowering estrogen levels to slow the growth of endometrial tissue. However, it is not a permanent solution—symptoms may return if treatment stops.
If conservative treatments fail and symptoms worsen, surgical excision of endometriosis is often the next step.
Conclusion
Understanding that adenomyosis and endometriosis are two distinct but disruptive gynecologic conditions is the first step toward finding effective treatment options and improving quality of life.
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