Adenomyosis: Symptoms, Causes, Diagnosis, Treatment, and Cure

Adenomyosis is a benign (non-cancerous) condition of the uterus in which tissue similar to the lining of the uterus is found within the muscular wall of the uterus. This can make the uterus thicker, larger, tender, and more painful during menstrual periods. Adenomyosis can cause heavy menstrual bleeding, painful periods, pelvic pain, and sometimes difficulty becoming pregnant, although symptoms vary widely from person to person.

Adenomyosis occurs when the endometrial tissue, which normally lines the uterus, starts to grow into the myometrium, the thick muscular layer of the uterus. This misplaced tissue causes the uterus to become enlarged, tender, and inflamed. Image Credit: Vectoressa via Canva.com.

Adenomyosis: Key Facts in Summary

• Adenomyosis is a benign condition in which endometrial-type tissue is present within the muscular wall of the uterus.


• It can cause heavy periods, painful cramps, chronic pelvic pain, pain during intercourse, and an enlarged or tender uterus.


• The exact cause is uncertain, but risk factors may include age, childbirth, and previous uterine surgery.


• Diagnosis is usually based on symptoms, pelvic examination, ultrasound, and sometimes MRI.


• Treatment may include pain relievers, hormonal therapy, uterine-sparing procedures, or surgery.


• Hysterectomy is the only definitive cure, but symptoms often improve after menopause.

What Is Adenomyosis?

The uterus has an inner lining called the endometrium and a thick muscular wall called the myometrium. In adenomyosis, endometrial-type tissue is present within the muscle layer of the uterus. Because this tissue responds to menstrual hormones, it can contribute to swelling, inflammation, pain, and heavy bleeding during periods.

Adenomyosis is noncancerous. It is not the same as uterine cancer, and it does not mean that a woman has cancer. However, it can cause symptoms that significantly affect quality of life. Some women have mild symptoms, while others have severe pain or heavy bleeding that interferes with work, family life, sleep, and daily activities.

Adenomyosis is often diagnosed in women in their late reproductive years, especially those in their 30s, 40s, or early 50s. However, it can occur earlier, and improved ultrasound and MRI imaging mean that it is now being recognized more often before hysterectomy.

Symptoms of Adenomyosis

The symptoms of adenomyosis can vary. Some women have no symptoms and only discover the condition during imaging or after surgery for another reason. Others have symptoms that are severe and persistent.
The most common symptoms include heavy menstrual bleeding, prolonged periods, severe menstrual cramps, pelvic pressure, chronic pelvic pain, and pain during intercourse. Some women describe a dragging, heavy, or tender feeling in the lower abdomen. A doctor may also find that the uterus feels enlarged, soft, tender, or “bulky” during a pelvic examination.

Heavy bleeding may lead to tiredness or iron deficiency anemia. This can cause weakness, shortness of breath on exertion, dizziness, or reduced energy. Pain may be worse during menstruation, but some women also have pelvic pain at other times of the month.

Adenomyosis can also occur together with other gynecological conditions, especially uterine fibroids and endometriosis. This can make symptoms more complex and can sometimes delay diagnosis.

Causes and Risk Factors of Adenomyosis

The exact cause of adenomyosis is not fully known. Several explanations have been proposed, and more than one mechanism may be involved.

One theory is that cells from the uterine lining grow directly into the muscle wall of the uterus. Another theory is that endometrial-type tissue becomes trapped in the uterine muscle during early development. A third possibility is that inflammation or injury at the boundary between the uterine lining and muscle allows tissue to move into the muscle layer.

Certain factors may increase the chance of adenomyosis. These include increasing age during the reproductive years, previous childbirth, and previous uterine procedures such as cesarean section, fibroid removal, or other surgery involving the uterus. These are risk factors, not definite causes. Many women with adenomyosis have no clear explanation for why it developed.

Adenomyosis is hormone-sensitive, especially in relation to estrogen. This is one reason symptoms often improve after menopause, when estrogen levels fall naturally.

How Adenomyosis Is Diagnosed

Adenomyosis can be difficult to diagnose based on symptoms alone because it can look similar to fibroids, endometriosis, heavy menstrual bleeding from other causes, or chronic pelvic pain conditions.

A doctor may start with a medical history, menstrual history, pelvic examination, and assessment of symptoms. Important details include the amount of bleeding, number of days of bleeding, severity of pain, pain during intercourse, fertility concerns, previous pregnancies, and previous uterine surgery.

Transvaginal ultrasound is commonly used as an initial imaging test. It may show features such as an enlarged uterus, thickened uterine muscle, an uneven muscle wall, small cyst-like spaces within the muscle, or changes suggestive of adenomyosis. MRI can provide more detailed images and may be useful when the diagnosis is uncertain or when surgery or fertility-preserving treatment is being considered.

The most certain diagnosis is made by examining the uterus under a microscope after hysterectomy. However, many women are now diagnosed and treated based on symptoms and imaging without needing removal of the uterus.

Prognosis of Adenomyosis

The prognosis for adenomyosis is generally good because the condition is benign. It does not spread like cancer. However, the symptoms can be long-lasting and distressing.

For many women, adenomyosis improves after menopause because the condition is hormone-dependent. Before menopause, symptoms may continue, fluctuate, or worsen over time. Heavy bleeding and pain should not be ignored, especially if they affect daily activities or cause anemia.

Adenomyosis can be associated with fertility problems in some women, but fertility depends on many factors, including age, egg quality, other uterine conditions, endometriosis, fibroids, and the overall reproductive history. Women who wish to become pregnant should discuss treatment carefully with a gynecologist, because some treatments are not suitable for those trying to conceive.

Treatment Options for Adenomyosis

Treatment depends on symptom severity, age, general health, fertility goals, and whether the woman wants to keep her uterus.

For mild symptoms, anti-inflammatory pain relievers such as ibuprofen or naproxen may help reduce menstrual pain and cramping. These medicines should be used only if they are safe for the individual, especially in people with kidney disease, stomach ulcers, bleeding problems, or those taking blood-thinning medication.

Hormonal treatments may help reduce bleeding and pain. These may include the combined oral contraceptive pill, progestin-only treatment, or a hormonal intrauterine device.

A hormonal IUD can be helpful for some women with heavy bleeding. Gonadotropin-releasing hormone agonists, such as leuprolide, may temporarily reduce estrogen levels and improve symptoms, but they are usually used for selected cases because of side effects and limitations with long-term use.

Uterine artery embolization may be considered in selected women. This procedure reduces blood flow to abnormal uterine tissue and may improve heavy bleeding and pain. However, it is not suitable for everyone, and women who want future pregnancy need careful specialist advice.

Image-guided treatments, such as MRI-guided or ultrasound-guided focused treatment, may be options in some centers, especially for localized adenomyosis or adenomyoma. Availability and suitability vary.

Surgery may be considered when symptoms are severe or when other treatments have not worked. Conservative surgery may remove a localized adenomyoma, but adenomyosis is often diffuse, meaning it spreads through the muscle wall rather than forming one clear lump. This makes complete removal difficult and recurrence possible.

Can Adenomyosis Be Cured?

Hysterectomy, which is surgical removal of the uterus, is the only definitive cure for adenomyosis. It removes the uterus and therefore removes the condition permanently. This option may be considered for severe symptoms when other treatments have failed and when future pregnancy is not desired.

A hysterectomy is not suitable for women who wish to become pregnant because pregnancy is no longer possible after the uterus is removed. For women who want fertility preservation, treatment focuses on symptom control, improving quality of life, and managing bleeding and pain while keeping the uterus.

Adenomyosis may also improve naturally after menopause. This is not the same as a treatment cure, but symptoms often settle when menstrual cycles stop and estrogen levels fall. Until then, treatment should be individualized.

When to See a Doctor for Adenomyosis Symptoms

Medical advice is important if periods are very heavy, painful, prolonged, or associated with pelvic pain between periods. Women should also seek help if they have pain during intercourse, worsening cramps, symptoms of anemia, difficulty becoming pregnant, or a uterus that feels enlarged or tender on examination.

Heavy menstrual bleeding should not be dismissed as normal, especially when it affects daily life or causes tiredness and low iron levels. A clear diagnosis can help distinguish adenomyosis from fibroids, endometriosis, and other causes of abnormal uterine bleeding.

This article is part of the 'Public Education Series' initiative by Exon Publications.

Disclaimer: This is for informational purposes only. For medical advice or diagnosis, consult a professional.

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