In short
Adenomyosis is when tissue like the lining of the uterus grows into its muscle wall. It can cause heavy, painful periods, pelvic pain and a bulky, tender uterus, though some women have no symptoms. It is diagnosed with ultrasound or MRI. Treatments range from hormonal options to procedures, and symptoms settle after menopause.
On this page
What is adenomyosis?
In adenomyosis, tissue similar to the lining of the uterus (the endometrium) grows into the muscle wall of the uterus. Each month that tissue responds to hormones the way the lining does, which makes the wall thicken, swell and become tender, and the uterus can become enlarged.1,8,10
It is a different condition from endometriosis, where similar tissue grows outside the uterus, though the two often occur together. See endometriosis vs adenomyosis.
Adenomyosis symptoms
- Heavy periods, sometimes with clots
- Painful periods, often with cramping that worsens over the years
- Pelvic pain or pressure outside of periods
- Pain during sex
- Bloating or a feeling of heaviness low in the abdomen
- Tiredness, which can be a sign of low iron from heavy bleeding
Some women with adenomyosis on a scan have no symptoms at all.1,8
Pain that stops you living your life isn’t normal.
Talk it through with an Australian doctor online. No referral needed.
How common is adenomyosis?
More common than once thought. Adenomyosis used to be diagnosed only after a hysterectomy, so it was seen as a condition of women in their 40s who had had children. With modern imaging it is now found in younger women too. In one study of 985 women attending a gynaecology clinic, ultrasound showed adenomyosis in about one in five.2
How common it is in the general population is still uncertain, because studies have mostly looked at women who already had symptoms or were having surgery.3
How is adenomyosis diagnosed?
Usually with a transvaginal ultrasound, read by someone experienced in looking for it. MRI is used when the ultrasound is unclear or when surgery is being planned. Both can show a thickened, uneven muscle wall and small pockets of lining tissue within it.4
International experts have agreed on a standard list of ultrasound features, so that scans are reported consistently.5 A normal-looking ultrasound doesn’t completely rule adenomyosis out.
Adenomyosis and fertility
Many women with adenomyosis conceive without help. On average, though, it seems to make pregnancy harder to achieve and to carry. A meta-analysis found that women with adenomyosis having IVF were 28 per cent less likely to become pregnant than women without it, and had a higher risk of early pregnancy loss.6
If you are planning a pregnancy, raise it early, because it changes which treatments make sense.
Adenomyosis treatment
Treatment depends on how severe your symptoms are, your age, and whether you want to become pregnant.
- Pain relief. Anti-inflammatory medicines taken around your period can ease cramping and reduce bleeding
- Hormonal treatments. A hormonal intrauterine device, and other hormonal options that thin the lining or pause periods, are the mainstay for heavy bleeding and pain7,8
- Treating low iron if heavy periods have run your stores down
- Uterine artery embolisation. A procedure that blocks the blood supply to the affected tissue. In a review covering more than 1,000 women, symptoms improved in 83 per cent9
- Hysterectomy. Removing the uterus is the only treatment that cures adenomyosis. It is an option when other treatments haven’t worked and you don’t want future pregnancies1
Because adenomyosis depends on hormones, symptoms usually ease after menopause.8
When to see a doctor
- Periods that soak through a pad or tampon every hour or two, last more than seven days, or contain large clots
- Period pain that stops you working, studying or sleeping
- Pelvic pain between periods or during sex
- Tiredness, dizziness or breathlessness with heavy periods
For ways to manage period pain in the meantime, see period pain relief.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol. 2016;23(2):164-85.
- Naftalin J, Hoo W, Pateman K, et al. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27(12):3432-9.
- Upson K, Missmer SA. Epidemiology of Adenomyosis. Semin Reprod Med. 2020;38(2-03):89-107.
- Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411.
- Harmsen MJ, Van den Bosch T, de Leeuw RA, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118-131.
- Vercellini P, Consonni D, Dridi D, et al. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964-77.
- Moawad G, Youssef Y, Fruscalzo A, et al. The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review. J Clin Med. 2023;12(19).
- Jean Hailes for Women’s Health. Adenomyosis.
- de Bruijn AM, Smink M, Lohle PNM, et al. Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol. 2017;28(12):1629-1642.e1.
- healthdirect. Adenomyosis.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.