Adenomyosis: what are the symptoms and treatments?
⏱ 4-minute read
Written by
Anastasia Nairne
Medically reviewed by
Dr Georgina Leslie, Clinical Lead at Bloomful
Updated on
15 Aug 2023
In this guide
➔ What is adenomyosis?
➔ What are the main symptoms?
➔ When should I see a doctor about my symptoms?
➔ Who is at risk of developing adenomyosis?
➔ What is the difference between adenomyosis and endometriosis?
➔ Can adenomyosis impact fertility?
➔ Can adenomyosis cause anaemia?
➔ How is adenomyosis diagnosed?
➔ How is adenomyosis treated?
Adenomyosis is a complex condition that develops when the layer of tissue that lines the uterus (known as the endometrium) starts growing into the muscular wall of the uterus. This tissue thickens, sheds and bleeds with each menstrual cycle. This can cause the uterus to swell and become tender and can lead to heavy, long and painful periods.
Adenomyosis can also co-exist with other conditions, and may even promote their development. More on this below.
What are the main symptoms?
The severity of your symptoms will depend on how much the tissue has penetrated the uterine wall and the number of adenomyosis lesions that have formed. Common symptoms include:
Heavy periods (having to change your tampon/pad every 1-2 hours and/or passing clots that are 2.5cm in diameter - about the size of a 10p coin)
Periods that last longer than 7 days
Severe period pain
Pain during sex
An enlarged uterus (this can be asymptomatic, but in some cases you may feel a heaviness in your lower abdomen or notice your abdomen protruding)
If you’re experiencing any of the above symptoms, you should speak to a doctor, especially if they last for more than three months. While short-term hormone fluctuations (brought on by stress, for example) may cause changes to your menstrual cycle, these will usually level out and your symptoms should subside. If symptoms persist for more than three months, then there may be an underlying condition.
Adenomyosis is still a deeply understudied condition so it’s difficult to pinpoint who is at a higher risk of developing it. Previously, it was believed to mainly affect women over the age of 40 but newer research shows that it’s increasingly being diagnosed in younger women. (1)
Adenomyosis is when endometrial tissue grows within the uterine wall, whereas in endometriosis, the tissue usually grows in or around your reproductive organs, including your ovaries, fallopian tubes and the outside surface of the uterus. In rare cases, it can also grow in other parts of the body.
While adenomyosis and endometriosis share a similar symptom profile, they are distinct conditions. However, research carried out on female baboons suggests there could be a potential symbiosis between endometriosis and adenomyosis - meaning that having one condition could create a favourable environment for the other to develop. (2)
While many women with adenomyosis are able to have children, the condition can cause complications.
When endometrial tissue grows into the uterine wall, changes can occur to the structure of the uterus and its lining, making it more difficult for a fertilised egg to implant and grow properly. This can lead to an increased risk of miscarriage.
The excessive bleeding and inflammation associated with adenomyosis can also create a challenging environment for fertilisation and implantation to take place. (3)
Seeking support from an experienced gynaecologist can help you assess your fertility and ensure your pregnancy is closely monitored if needed.
Adenomyosis often causes heavy periods, which can lead to iron deficiency and, in more severe cases, iron deficiency anaemia. (4) Anaemia results in reduced oxygen being supplied to tissues and organs. Symptoms include:
Tiredness
Weakness
Shortness of breath
Pale or yellowish skin
An irregular heartbeat
Dizziness or lightheadedness
Chest pain
Cold hands and feet
Up to 2 in 3 women with recurring heavy periods develop anaemia (5), which is one of the reasons it’s important to see a doctor if your period is heavy.
Transvaginal ultrasound
An examiner inserts an ultrasound device into the vagina to check for signs that point to adenomyosis (for example, lesions or an enlarged uterus).
Hysteroscopic biopsy
A small device is inserted into the vagina to collect a tissue sample from the endometrium (the lining of the uterus). This tissue is then analysed in a lab to check for evidence of adenomyosis.
MRI
This non-invasive imaging test is usually done after an ultrasound, as a second-line examination technique. A magnetic resonance imaging scanner is used to produce pictures of your uterus, which are then analysed for signs of adenomyosis.
Pain medication
Doctors may initially suggest anti-inflammatory medication to see if your symptoms ease up. Ibuprofen and paracetamol can be taken together to boost the pain relief effects.
Mefenamic acid and tranexamic acid are also commonly prescribed. The first is a stronger painkiller from the ibuprofen ‘family’, while the second helps reduce bleeding and, as a result, can lessen the pain.
Hormone treatment
Hormone-based treatments can help reduce endometrial tissue growth by limiting the production of oestrogen. By doing this, the therapy helps to reduce the growth of adenomyosis and alleviates the main symptoms, including heavy and painful periods. Hormone treatment options include:
Oral contraceptives: Combination birth control pills that contain oestrogen and progestin (a synthetic form of progesterone) can help control heavy bleeding and pain.
Progestin therapy: Progestin-only medications, such as oral progestins or the levonorgestrel-releasing intrauterine system, can help reduce bleeding and pain. The latter is a popular contraceptive option, which you may know by its brand name Mirena. This IUD device can remain in your uterus for up to seven years.
Gonadotropin-releasing hormone agonists: These medications temporarily induce a state of menopause, suppressing oestrogen production and reducing symptoms. They are usually used for short periods because of potential side effects.
Uterine artery embolization (UAE)
This minimally invasive procedure involves blocking the vessels that supply blood to the adenomyosis tissue.
Hysterectomy
In severe cases or when other treatments have been ineffective, a hysterectomy (the surgical removal of the uterus) may be recommended. This is a definitive treatment and eliminates the possibility of future pregnancies.
Key takeaways
Adenomyosis is a complex condition that can lead to heavy, long and painful periods and can also co-exist with other gynae abnormalities such as endometriosis.
Aside from causing debilitating symptoms, adenomyosis can also impact fertility, so it’s important to speak to a specialist who can assess and support you if needed.
There are a number of treatments, most of which help to alleviate the symptoms. Knowing your options, as well as the potential side effects will help you find a care plan that works best for you.
References
(1). Recent advances in understanding and managing adenomyosis (Published: 2019 Authors: Silvia Vannuccini, Felice Petraglia)
(2). Adenomyosis in the baboon is associated with primary infertility (Published: 2004 Authors: Breton F Barrier, Marshall J Malinowski, Edward J Dick)
(3). Adenomyosis and infertility (Published: 2012 Authors: Campo S, Campo V, Benagiano G)
(4). The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia (Published: 2023 Authors: Malcolm G Munro, Alan E Mast, Jacquelyn M Powers)
(5). Heavy periods (Menorrhagia) and Dysfunctional uterine bleeding (Published: 2020 Authors: Wirral University Teaching Hospital)
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