Adenomyosis: A Condition of the Uterus

Medically Reviewed By Valinda Riggins Nwadike, MD, MPH
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Adenomyosis is a common but lesser-known medical condition that affects the female reproductive system. It occurs when endometrial tissue grows into the walls of the uterus. Although adenomyosis is not a serious condition, treatment may be necessary to avoid possible complications, including infertility. Symptoms may include irregular bleeding and intense pelvic pain.

This article describes adenomyosis symptoms, diagnosis, and treatment. It will also explore possible causes of adenomyosis and the differences in adenomyosis versus endometriosis.

Sex and gender

Sex and gender exist on spectrums. This article will use the term “female” to refer to a person’s sex assigned at birth.

What is adenomyosis? 

two women talking on couch
Jelena Jojic Tomic/Stocksy United

When a person with a uterus has adenomyosis, the cells that line the uterus grow within the uterine wall (myometrium).

Adenomyosis is often mistaken for other conditions because symptoms resemble endometriosis or uterine fibroids. Treatment depends on the symptoms and may include pain relievers, hormonal therapy, or a hysterectomy.

Adenomyosis itself is not usually a serious condition, but there is an association between adenomyosis and endometrial cancer.

Adenomyosis vs. endometriosis

Adenomyosis and endometriosis are both conditions related to the endometrial tissue in the uterus. The main difference is the location for the growth of endometrial cells. 

Adenomyosis occurs due to endometrial-like cells growing within the muscle of the uterus. As the uterine wall thickens during the menstrual cycle, this may cause heavy bleeding and pain

Endometriosis is a common condition that affects an estimated 10% of females (assigned at birth) in their reproductive years. When a person has endometriosis, the endometrial-like cells develop outside the uterus. 

It is possible to develop both endometriosis and adenomyosis. 

What are the symptoms of adenomyosis?

Symptoms of adenomyosis can range from mild to severe. A retrospective study of 182 people, most older than 40 years, found that one-third had no symptoms before an official diagnosis. 

Symptoms of adenomyosis may include: 

  • heavy menstrual bleeding
  • severe pelvic pain during period
  • blood clots during menstrual bleeding
  • irregular bleeding between periods
  • pain during intercourse
  • infertility

Symptoms can resemble other gynecological conditions, such as polyps, endometriosis, endometrial cancer, and uterine fibroids. Therefore, it is important to contact a medical professional if you start experiencing unusual symptoms.

Without treatment, adenomyosis can eventually affect a person’s quality of life due to excessive bleeding that interferes with daily activities. Excessive blood loss also increases the chance of anemia and iron deficiency. 

What causes adenomyosis?

Adenomyosis is likely a condition reactive to hormones, as it frequently disappears after people enter menopause. This time coincides with a decline in estrogen levels.

Although there is no definite cause of adenomyosis, doctors believe genetic predisposition, an immunocompromised state, and hormonal changes play a role.

The exact cause of adenomyosis is not known, but factors associated with it include: 

  • having more than one pregnancy
  • cesarean delivery
  • uterine surgery
  • exposure to estrogen

Research estimates that adenomyosis affects 1 in 10 females of reproductive age. However, this number may be closer to 20%, according to the National Cancer Institute and a 2019 review article.

Most people receive a diagnosis at 40–50 years of age. However, adenomyosis diagnoses are increasing among younger females. This may be due, in part, to a shift in diagnostic methods from hysterectomy pathology reports to ultrasound.

Adenomyosis and pregnancy

Research is still ongoing to understand the potential short- and long-term effects of adenomyosis on fertility. A 2016 study correlates adenomyosis and childbearing, not impaired fertility. 

A 2021 review article notes that adenomyosis diagnoses during pregnancy are increasing due to the recent tendency of later maternal age. A diagnosis of adenomyosis has become more common at routine pregnancy examinations in the first trimester. 

Rare but serious maternal complications related to adenomyosis may include:  

Researchers agree that a correct diagnosis of adenomyosis is essential to ensure fetal and maternal health. 

How do clinicians diagnose adenomyosis?

The doctor will perform a pelvic exam and ask about atypical symptoms related to your menstrual cycle, including irregular bleeding between periods and sharp pain in the pelvis. They may also ask about any personal or family history of female reproductive conditions.

Your doctor will also ask about the timeline of your symptoms, so it can be useful to keep track of irregularities in your monthly cycle. 

Adenomyosis can enlarge the uterus up to three times its usual size. If the doctor notes an enlarged uterus during the pelvic exam, they may recommend further tests to gather more information and confirm adenomyosis. Tests may include: 

  • transvaginal ultrasound
  • MRI
  • endometrial biopsy  

An adenomyosis diagnosis may be difficult to confirm. If there is uncertainty, a second opinion from another clinician may help. 

What are the treatment options for adenomyosis?

Treatment for adenomyosis depends on the severity of symptoms. People who experience mild to no symptoms may not need treatment.

If symptoms become severe and interfere with your quality of life, the doctor will likely recommend treatment. The goal is to reduce or eliminate symptoms. Clinicians usually start with conservative treatment.

Nonsurgical treatments and procedures

Specific treatments to reduce symptoms of adenomyosis may include: 

  • Anti-inflammatory medications: These help relieve cramps before and during the menstrual cycle.
  • Hormonal treatments: These medications manage estrogen levels. 
  • Endometrial ablation: This is an outpatient procedure to remove the uterine lining, or the endometrium.
  • Uterine artery embolization: This is a minimally invasive surgery that limits blood supply to certain arteries in the uterus. The reduced blood supply shrinks the affected tissue.
  • Ultrasound surgery: This is a procedure that uses monitored heat to remove adenomyosis. 

Myomectomy for adenomyosis 

Myomectomy is a surgical procedure where the doctor cuts out the affected tissue. It is a common treatment for uterine fibroids. Gynecologists may recommend it to people who want to preserve fertility. The purpose of a myomectomy is to preserve the uterus and relieve symptoms.  

Hysterectomy for adenomyosis 

A hysterectomy is the only way to treat and cure adenomyosis. With other procedures and myomectomy, adenomyosis and symptoms can return.

Since a hysterectomy is major surgery and involves complete removal of the uterus, doctors recommend it for severe adenomyosis when the patient is not planning a future pregnancy. 

Talk with your doctor about all your treatment options, including the potential benefits and risks of each. If you need more information, consider seeking a second opinion. 

Outlook

Adenomyosis is not a life threatening condition, but it may interfere with regular activities, lifestyle, and mental health. 

Early diagnosis of adenomyosis can lead to the management of symptoms and possible prevention of complications.

A recent study from Taiwan, involving 12,447 females with adenomyosis, found that endometrial cancer and thyroid cancer were present at higher rates in females with adenomyosis than without it. It is crucial to seek medical evaluation as symptoms emerge. 

Treatment options can improve symptoms and help people recover their quality of life. The only treatment that cures adenomyosis is a hysterectomy, but ongoing clinical research is expanding the options for noninvasive procedures.

In most cases of adenomyosis, symptoms go away after a person reaches menopause due to low estrogen levels. 

Summary

Adenomyosis is a common condition that affects people with uteruses in their reproductive years. It develops as endometrial tissue starts to grow into the muscular wall of the uterus. Symptoms can range from mild to severe and include irregular bleeding between periods and intense cramps.

Although adenomyosis is not life threatening, symptoms can interfere with daily activities and increase the risk for infertility.

A doctor will determine treatment options depending on symptoms. These treatments may include medications, removing the adenomyosis, and hysterectomy. Research on adenomyosis is limited, and doctors have not determined a specific cause for the condition.

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Medical Reviewer: Valinda Riggins Nwadike, MD, MPH
Last Review Date: 2022 May 27
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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