What is Adenomyosis?
Adenomyosis is a condition where the tissue that normally lines the uterus (the endometrium) starts to grow into the muscular wall of the uterus (the myometrium). This can cause the uterus to become enlarged, thicker, and more sensitive.
It is a benign (non-cancerous) condition, but it can cause significant discomfort and heavy bleeding. In the past, this may have only been diagnosed after a hysterectomy but today, advanced ultrasound and better definitions mean this is more easily diagnosed.
Who does it affect?
- Most common in women aged 30–50
- Often diagnosed in those who have had children
- May be more likely in people with a history of endometriosis or uterine surgery (e.g. C-section)
What are the symptoms?
Some people with adenomyosis have no symptoms, but common ones include:
- Heavy or prolonged periods (menorrhagia)
- Severe period pain (dysmenorrhea)
- Pelvic pain or pressure
- Bloating or feeling of fullness
- Pain during sex
- Fatigue due to blood loss (anaemia)
- Enlarged, tender uterus (sometimes felt as a “bulky” womb)
Symptoms often improve after menopause.
What causes adenomyosis?
The exact cause isn’t known, but possible factors include:
- Hormonal influence – especially oestrogen
- Childbirth-related changes in the uterus
- Inflammation or trauma to the uterine wall (e.g. surgery)
How is adenomyosis diagnosed?
Diagnosis can be difficult and often exists with other conditions like fibroids or endometriosis. Tests may include:
- Pelvic examination
- Ultrasound scan (may show an enlarged, thickened uterus), usually first line
- MRI scan – more detailed imaging to detect changes in the uterus
- Biopsy or histology (definitive diagnosis is sometimes only confirmed after hysterectomy)
What is the Best Treatment for Adenomyosis?
Adenomyosis affects women in different ways, and the best treatment option is tailored to your specific symptoms, age (as adenomyosis often improves after menopause), previous treatments, your preferences regarding surgery, and whether you plan to have children. Common treatments for adenomyosis include:
- Anti-inflammatory Medications and Pain Relief: Medications like ibuprofen can help manage pain and reduce bleeding. In some cases, starting anti-inflammatories a few days before your period and continuing during menstruation can be particularly effective.
- Hormonal Treatments: Hormone-based therapies such as the combined oestrogen-progesterone pill or hormone patches can help regulate symptoms. A progesterone-releasing intrauterine device (IUD) or continuous progesterone-only pills may also be recommended to stop menstruation and alleviate symptoms.
- Non-Hormonal Treatments: Medications like tranexamic acid can reduce heavy menstrual bleeding without affecting hormone levels.
- Uterine Artery Embolization (UAE): This minimally invasive procedure involves introducing tiny particles into the blood vessels through a catheter in the groin to block the blood supply to the adenomyosis, causing it to shrink.
- Hysterectomy: If symptoms are severe and other treatments have not been effective, a hysterectomy (removal of the uterus) may be recommended. This is the only treatment that completely resolves adenomyosis but is only suitable for women who are not planning further pregnancies.
Choosing the right treatment depends on your symptoms, future fertility plans, and overall health. Our specialist team at WWWW is here to guide you through your options with expert care and support.
Adenomyosis and Fertility
Understanding the impact of adenomyosis on fertility can be challenging due to several factors:
- Limited Research: The relationship between adenomyosis and fertility is still not fully understood, and more research is needed to clarify its effects.
- Age Factor: Adenomyosis is more commonly diagnosed in women over 35, an age group where fertility naturally begins to decline.
- Associated Conditions: Many women with adenomyosis also have conditions such as endometriosis, uterine fibroids or polyps, which can also impact fertility.
However, recent research provides clearer insight. A meta-analysis revealed that adenomyosis has a negative effect on IVF outcomes. The study found that women with adenomyosis experienced:
- Lower pregnancy rates per cycle and per embryo transfer
- Reduced chances of successful embryo implantation
- Lower rates of continuing pregnancy and live birth
- Higher rates of miscarriage
These findings persisted even when adjusting for age and other factors, indicating that adenomyosis independently affects reproductive outcomes.
At WWWW, we understand how important your fertility journey is.
Are Endometriosis and Adenomyosis the Same?
No, endometriosis and adenomyosis are similar but distinct conditions. While they share some overlapping symptoms, they affect different parts of the body and often require different treatment approaches.
- Endometriosis occurs when tissue similar to the lining of the womb (endometrium) grows outside the
uterus, often affecting the ovaries, fallopian tubes, and pelvic tissue. - Adenomyosis involves the same type of tissue growing within the muscular wall of the uterus itself,
leading to heavy periods, pain, and an enlarged uterus.
Some women may have both conditions simultaneously, which can sometimes make diagnosis and treatment more complex.
At WWWW, we provide comprehensive assessment and tailored treatment plans to manage both endometriosis and adenomyosis, ensuring you receive the most effective care for your individual needs.
Living with adenomyosis
Adenomyosis can be challenging, especially if it affects your quality of life. But you’re not alone, and effective treatments are available. With the right support, most people find relief from their symptoms.
Our dedicated team is here to support your gynaecological health with sensitivity, expertise, and the very best in modern care.