Adenomyosis: Symptoms, Causes, Diagnosis, and Treatment

During the menstrual cycle, this tissue may thicken and bleed in response to hormones. Because it is located within uterine muscle, it may contribute to swelling, inflammation, painful contractions, and heavy periods.

The condition is not cancer, and some people need no treatment because they have mild symptoms or none at all.

• adeno-, referring to gland-like tissue;
• myo-, meaning muscle;
• -osis, meaning a condition or abnormal process.

It is generally uncountable:

• She was diagnosed with adenomyosis.
• Adenomyosis may cause painful and heavy periods.
• The ultrasound showed features consistent with adenomyosis.

The adjective is adenomyotic:

• adenomyotic tissue;
• an adenomyotic uterus;
• adenomyotic changes.

Common expressions include:

• symptoms of adenomyosis;
• diffuse adenomyosis;
• focal adenomyosis;
• suspected adenomyosis;
• adenomyosis-related pelvic pain;
• treatment for adenomyosis.

The main layers include:

• endometrium, the inner lining that thickens and sheds during the menstrual cycle;
• myometrium, the thick muscular wall responsible for uterine contractions;
• serosa, the outer covering of the uterus.

In adenomyosis, endometrial-like glands and supporting tissue are found within the myometrium. This may cause the muscle wall to thicken and the uterus to become enlarged.

Diffuse Adenomyosis

Diffuse adenomyosis is spread through a larger area of the uterine muscle.

It may cause:

• general thickening of the uterine wall;
• an enlarged uterus;
• widespread tenderness;
• heavy bleeding;
• menstrual pain.

Focal Adenomyosis

Focal adenomyosis affects a more limited area.

A localized mass formed by adenomyotic tissue is sometimes called an adenomyoma. It may resemble a uterine fibroid on imaging, although the two conditions involve different types of tissue.

• heavy or prolonged menstrual bleeding;
• severe menstrual cramps;
• chronic pelvic pain;
• pressure or fullness in the lower abdomen;
• pain during or after penetrative sex;
• tenderness in the uterine area;
• bleeding between periods in some cases;
• tiredness associated with blood loss.

Heavy bleeding may contribute to iron-deficiency anemia, which can cause weakness, dizziness, shortness of breath, or fatigue.

Some people have adenomyosis without experiencing any symptoms.

Proposed explanations include:

• direct movement of endometrial tissue into the uterine muscle;
• changes at the boundary between the endometrium and myometrium;
• tissue changes following childbirth or uterine surgery;
• developmental differences in uterine tissue;
• inflammation related to pregnancy or menstruation;
• hormone-related growth of misplaced tissue.

These explanations remain theories rather than one confirmed cause that applies to every case.

• are in their later reproductive years;
• have given birth;
• have had uterine surgery, such as cesarean delivery;
• have endometriosis or uterine fibroids.

However, adenomyosis can occur in younger people and in those who have never been pregnant or had uterine surgery.

Improved ultrasound and MRI techniques have allowed the condition to be identified more often without hysterectomy.

Adenomyosis:

• affects the muscular wall of the uterus;
• may enlarge the uterus;
• often causes heavy bleeding and menstrual pain.

Endometriosis:

• occurs outside the uterus;
• may affect the ovaries, fallopian tubes, pelvic lining, bowel, or bladder;
• often causes pelvic pain, painful sex, or fertility difficulties.

A person may have both conditions at the same time.

Adenomyosis involves endometrial-like tissue within the uterine muscle.

Both conditions may cause:

• heavy periods;
• pelvic pressure;
• painful menstruation;
• an enlarged uterus;
• fertility concerns.

Ultrasound or MRI may help distinguish them, although they can coexist.

• discussion of symptoms and menstrual history;
• pelvic examination;
• blood tests for anemia;
• transvaginal or abdominal ultrasound;
• magnetic resonance imaging;
• evaluation for fibroids, endometriosis, or other causes.

Ultrasound or MRI can identify features suggesting adenomyosis, but similar symptoms may occur with several uterine and pelvic conditions.

Historically, adenomyosis was confirmed mainly by examining the uterus after hysterectomy. Modern imaging now allows a probable clinical diagnosis without removing the uterus.

Possible treatments include:

• anti-inflammatory pain medication;
• medicines that reduce menstrual bleeding;
• combined hormonal contraception;
• progestin-only treatment;
• a levonorgestrel-releasing intrauterine system;
• other hormone-suppressing medicines;
• procedures targeting uterine tissue in selected cases;
• hysterectomy for severe symptoms when other options are unsuitable.

A hysterectomy removes the uterus and is considered a definitive treatment because adenomyosis occurs within the uterine wall. It is not appropriate for someone who wishes to carry a future pregnancy.

Adenomyosis may be associated with:

• difficulty conceiving;
• changes in uterine contractions;
• altered implantation conditions;
• miscarriage risk;
• reduced success with some fertility treatments.

However, many people with adenomyosis become pregnant naturally or with medical assistance. The condition does not automatically mean infertility.

A fertility specialist may consider age, ovarian reserve, sperm factors, fallopian-tube health, endometriosis, and other reproductive conditions alongside adenomyosis.

Pregnancy outcomes depend on many factors, and the presence of adenomyosis does not mean that complications will occur. Anyone planning pregnancy should discuss current medication and symptom-management options with a healthcare professional because some hormonal treatments prevent conception while being used.

Pain may vary according to:

• penetration depth;
• sexual position;
• menstrual-cycle timing;
• uterine tenderness;
• pelvic-floor tension;
• the presence of endometriosis or another pain condition.

Helpful adjustments may include controlling depth and speed, choosing comfortable positions, using adequate lubrication, and stopping when pain begins.

Pain should not be treated as something a person must tolerate to satisfy a partner.

• periods that are increasingly painful;
• very heavy or prolonged bleeding;
• pelvic pain that affects daily life;
• pain during sex;
• abdominal fullness or pressure;
• symptoms of anemia;
• difficulty becoming pregnant.

Urgent care may be needed for extremely heavy bleeding, fainting, severe sudden pelvic pain, pregnancy-related pain, or symptoms suggesting significant blood loss.

It is a form of uterine cancer.
No. Adenomyosis is a noncancerous condition.

Everyone with adenomyosis has severe symptoms.
No. Some people have mild symptoms or none.

Adenomyosis always causes infertility.
No. Pregnancy may still occur naturally or with assistance.

Hysterectomy is the only treatment.
No. Pain medicines, hormonal methods, and other treatments may reduce symptoms.

Pain during sex means lack of desire.
No. A person may desire intimacy while experiencing involuntary pelvic pain.

1. Adenomyosis occurs when endometrial-like tissue is present within the uterine muscle.
2. Her adenomyosis caused heavy periods and severe cramps.
3. Can adenomyosis cause pain during sexual intercourse?
4. Ultrasound showed thickening of the uterine wall.
5. Adenomyosis and endometriosis may occur together.
6. Hormonal treatment helped reduce menstrual bleeding.
7. The specialist discussed fertility goals before recommending treatment.
8. Understanding adenomyosis helps readers distinguish it from fibroids and endometriosis.

The condition may also influence decisions about contraception, fertility treatment, pregnancy, and hysterectomy. Treatment should therefore reflect both symptom relief and the individual’s reproductive goals.

Understanding adenomyosis helps people discuss uterine pain without shame and reinforces that painful sexual activity should never be forced or treated as a measure of attraction.