Adenomyosis is a condition where the cells of the uterine lining grow into the muscular wall of the uterus. It is similar to endometriosis and can cause similar symptoms or no symptoms at all.

Shadow of a female on pavement.Share on Pinterest
Lyu Wenzhuo/EyeEm/Getty Images

Adenomyosis is a relatively widespread condition. According to a qualitative analysis of 16 research studies, 20–88.8% of women who experienced adenomyosis symptoms had the condition, with an average of 30–35%. Most women receive a diagnosis within the ages of 32–38 years.

However, these figures can be an underestimation, as doctors usually diagnose the condition by examining a person’s uterus following a hysterectomy. This means that the research may not be considering other individuals.

This article gives an overview of adenomyosis, including symptoms, causes, diagnosis, complications, and treatment.

Adenomyosis is a gynecologic condition where the cells that usually line the inside of the uterus grow inward into the uterine muscle.

During a person’s menstrual cycle, these “trapped” cells undergo stimulation by the hormones of the menstrual cycle, similar to the mucous membrane lining of the uterus. This can make menstrual cramps and bleeding more severe than usual.

The symptoms of adenomyosis vary throughout the menstrual cycle because of rising and falling levels of estrogen, which affect the shedding of the uterus lining.

Symptoms usually go away or improve after menopause, when a person’s estrogen levels naturally decrease.

Adenomyosis and endometriosis are very similar, but there are differences.

In adenomyosis, cells lining the uterus grow into the uterus muscle. In endometriosis, these cells grow outside the uterus, sometimes on the ovaries and fallopian tubes.

These two conditions are equally widespread, though endometriosis occurs more often in women in their 30s and 40s, while more women aged 40–50 years tend to develop adenomyosis.

It is possible for a person to have both endometriosis and adenomyosis. The symptoms of both conditions should subside after menopause.

Adenomyosis symptoms vary widely among people. Around one-third of women do not experience any symptoms at all, while for others, symptoms can disrupt daily life.

Possible symptoms of adenomyosis include:

  • heavy menstrual bleeding
  • very painful periods
  • pain during sex
  • bleeding between periods
  • worsening uterine cramps
  • an enlarged and tender uterus
  • general pain in the pelvic area
  • a feeling that there is pressure on the bladder and rectum
  • pain while having a bowel movement

Doctors are not sure what causes adenomyosis, but there are several theories:

  • Fetal development: Adenomyosis may be present in a person before birth when the uterus first forms in a fetus.
  • Inflammation: Inflammation that occurs in a person’s uterus during uterine surgery could also increase the risk of adenomyosis.
  • Invasive tissue: Injury to the uterus, such as during a cesarean delivery or other surgery, may also cause adenomyosis. This is because the endometrial-like tissue grows into the muscle.

Some risk factors that may result in adenomyosis include:

  • Estrogen: Conditions that increase the time of exposure to estrogen may include menopause, a higher body mass index, or past use of hormonal contraceptives.
  • Age: This condition can affect individuals of any age. However, many people do not receive a diagnosis of adenomyosis until during or after menopause after having a hysterectomy.
  • Pregnancy: A high percentage of females with adenomyosis have had multiple pregnancies.
  • Uterine surgery: Having previous surgery on the uterus, including cesarean delivery, may increase the risk of adenomyosis.

Diagnosing adenomyosis begins with a consultation with a doctor. They will likely take a medical history and perform a physical and pelvic exam.

A person will often feel tenderness in her uterus during the pelvic exam. If a doctor thinks that the uterus feels slightly enlarged and they suspect adenomyosis, they may consider other tests, including:

  • Ultrasound: This allows the doctor to examine pockets of the uterus lining tissue in the muscle of the uterus.
  • MRI: An MRI scan is a common way for the doctor to see the inner uterus muscle.
  • Endometrial biopsy: Sometimes, the doctor will want to take a small sample of the endometrial tissue in the uterus for testing. While it will not help diagnose adenomyosis, it will rule out other causes of a person’s symptoms.

However, these tests will not give a definite diagnosis. It is only possible to definitively diagnose adenomyosis once a person has had a hysterectomy and a specialized doctor called a pathologist examines the uterus under the microscope.

Without treatment, adenomyosis may remain the same or worsen.

Treatment is not necessary if a person has no symptoms, is not trying to get pregnant, or is nearing menopause, which is when most people find relief from their symptoms.

However, there are many different treatment options available:

  • Anti-inflammatory medications: Medications, such as ibuprofen, can reduce pain and discomfort.
  • Medications: Oral contraceptive pills, progestin intrauterine devices, or injections (Depo-Provera) can help ease symptoms. In addition, doctors can prescribe gonadotropin-releasing hormone agonists or antagonists, but usually only in the short term, as they can induce false or temporary menopause. In rare cases, healthcare professionals may prescribe them for the long term if a person does not respond to other treatments.
  • Uterine artery embolization: This involves placing a tube in a major artery in the groin and injecting small particles into the affected area. This stops the blood supply from reaching the area, shrinking the adenomyosis and reducing symptoms.
  • Hysterectomy: The only definitive treatment for adenomyosis is the complete removal of the uterus. It may be an unsuitable option for a person who still wants to become pregnant unless all therapies have failed and they wish to prioritize pain relief over pregnancy.

Some data sources show an approximate 11–12% association between infertility and adenomyosis.

However, the research suggesting that adenomyosis may have an impact on a person’s fertility is conflicting, as there are often other conditions present in individuals with fertility issues.

Research into the relationship between adenomyosis, infertility, and pregnancy complications is still ongoing. One 2017 study showed that in patients with adenomyosis, the rate of pregnancy loss before 12 weeks of pregnancy is 15.2%. After 12 weeks, the risk is 9.1–10.9%, depending on the specific type of adenomyosis a person has.

A person who is not trying to get pregnant or not experiencing any symptoms may not require treatment. However, anyone who suspects adenomyosis should speak with their doctor for evaluation.

If a person is experiencing heavy periods or severe uterine cramping, it is essential that they speak with their doctor. These symptoms can signal other serious conditions, and it is important that the doctor performs an evaluation to determine their cause.

Adenomyosis is not a life threatening condition on its own.

Although the condition will go away once a person reaches menopause, it can cause severe discomfort and lead to complications before then.

An individual should consult their doctor if they suspect adenomyosis or endometriosis. Several treatments can help alleviate the symptoms.

Below are common questions relating to adenomyosis.

What are the complications of adenomyosis?

c

Learn more about anemia.

Can you cure adenomyosis?

The only definitive cure for adenomyosis is a hysterectomy, which involves the complete removal of the uterus.

What happens in adenomyosis without treatment?

Without treatment, a person’s adenomyosis symptoms may worsen. In addition, adenomyosis can co-occur with other conditions such as fibroids or endometriosis.