Adenomyosis: Symptoms, Diagnosis & Treatment

9 min read
Adenomyosis: Symptoms, Diagnosis & Treatment

Adenomyosis is a condition affecting the uterus that can cause periods to become unusually heavy, painful or both.

It happens when tissue similar to the lining of the uterus is found within the muscular wall of the uterus.

For some people, adenomyosis causes few or no symptoms. For others, periods can become painful enough to interfere with work, exercise, sleep and everyday life.

Heavy bleeding can also mean passing larger or more frequent period blood clots and may lead to iron deficiency.

Adenomyosis is sometimes confused with endometriosis, but they arenโ€™t the same condition, although you can have both.

Key takeaways

  • Adenomyosis occurs when endometrial-like tissue is present within the muscular wall of the uterus.
  • Common symptoms include heavy periods, painful periods and pelvic pain.
  • Some people with adenomyosis have no symptoms.
  • Adenomyosis and endometriosis are different conditions but can occur together.
  • Ultrasound and sometimes MRI can help diagnose adenomyosis.
  • Treatment depends on symptoms, stage of life and future pregnancy plans.
  • Options can include pain relief, medicines to reduce bleeding, hormonal treatment and surgery.

On this page

What is adenomyosis?

The uterus has an inner lining called the endometrium and a thick muscular wall called the myometrium.

With adenomyosis, cells similar to those of the endometrium are found within this muscular wall.

The affected uterine muscle can become thicker and the uterus may become enlarged or tender.

Healthdirect estimates adenomyosis affects around 1 in 5 females, although the true number is difficult to know because some people have no symptoms and imaging techniques have improved over time.

What are the symptoms of adenomyosis?

Symptoms vary widely.

They can include:

  • heavy periods
  • periods lasting longer than usual
  • significant menstrual cramps
  • pelvic pain between periods
  • pain during sex
  • a feeling of pelvic heaviness or pressure
  • passing larger menstrual blood clots

Some people have mild symptoms. Others experience pain or bleeding severe enough to interfere with work, school, exercise, sleep or relationships.

And some people with adenomyosis experience no obvious symptoms at all.

Can adenomyosis cause period blood clots?

Yes. Adenomyosis can cause heavy menstrual bleeding, and heavy flow can make menstrual clots larger or more noticeable.

Clots themselves donโ€™t diagnose adenomyosis.

But if youโ€™re regularly passing large clots alongside increasingly painful or heavy periods, adenomyosis is one possible cause your doctor may consider.

Read our guide to period blood clots for more on what can be normal and when bleeding is worth checking.

Adenomyosis vs endometriosis: whatโ€™s the difference?

The names sound similar and the symptoms can overlap, but adenomyosis and endometriosis occur in different places.

Adenomyosis Endometriosis
Endometrial-like tissue is found within the muscular wall of the uterus Endometrial-like tissue grows outside the uterus
Often associated with heavy and painful periods Often associated with pelvic pain, painful periods and pain in other parts of the pelvis
May cause an enlarged or tender uterus Can affect the ovaries, pelvic lining, bowel, bladder and other sites

You can have adenomyosis and endometriosis at the same time.

Read our guide to endometriosis for more.

Adenomyosis vs fibroids

Fibroids and adenomyosis can both affect the muscular wall of the uterus, but theyโ€™re different conditions.

A fibroid is a distinct non-cancerous growth made from uterine muscle and fibrous tissue.

Adenomyosis is more diffuse in many people, with endometrial-like tissue growing within the muscle itself.

Both can cause heavy periods, menstrual clots, pain and an enlarged uterus, and some people have both conditions.

What causes adenomyosis?

We still donโ€™t fully understand why adenomyosis develops.

Several theories have been proposed about how endometrial-like cells become established within the uterine muscle, but there isnโ€™t one proven cause.

Healthdirect notes that having had surgery or procedures involving the uterus may be associated with an increased likelihood of adenomyosis, but adenomyosis also occurs in people who havenโ€™t had uterine surgery.

It isnโ€™t caused by something you ate, how much you exercise or anything you did wrong.

How is adenomyosis diagnosed?

Your doctor will usually ask about:

  • how heavy your periods are
  • how long they last
  • period and pelvic pain
  • pain during sex
  • pregnancy and fertility history
  • how symptoms affect your daily life

They may also recommend a pelvic examination.

Ultrasound

Pelvic ultrasound is commonly used when adenomyosis is suspected.

A transvaginal ultrasound may provide clearer images of the uterus. You should be told what the test involves and asked for your consent.

MRI

An MRI may sometimes be recommended if ultrasound findings arenโ€™t clear or more information is needed before treatment.

Blood tests

If you have heavy bleeding, blood tests may be arranged to check for iron deficiency and anaemia.

How is adenomyosis treated?

Treatment depends on how much the condition is affecting you, your age and stage of life and whether you want to become pregnant in the future.

You donโ€™t necessarily need treatment if adenomyosis is found but isnโ€™t causing troublesome symptoms.

Heat and everyday pain relief

Heat packs and warm baths can help some people manage cramping.

TENS is also used by some people for period pain. Healthdirect notes that research specifically showing benefit for adenomyosis remains limited, although some people find TENS helpful for managing pain.

Anti-inflammatory medicines

Anti-inflammatory medicines such as ibuprofen, naproxen or mefenamic acid may reduce period pain and can also reduce menstrual bleeding for some people.

They arenโ€™t suitable for everybody, so check with your doctor or pharmacist if youโ€™re unsure.

Tranexamic acid

Tranexamic acid is a non-hormonal medicine used during the period to reduce heavy menstrual bleeding.

It doesnโ€™t treat the adenomyosis itself but can help control bleeding for some people.

Hormonal treatment

Hormonal options may reduce both bleeding and pain.

Depending on your circumstances, these may include:

  • a hormonal IUD
  • the combined contraceptive pill
  • progestogen-only treatment
  • a contraceptive implant

A hormonal IUD is frequently used for heavy menstrual bleeding and can be particularly useful for some people with adenomyosis.

Surgery

Surgical treatment may be considered when symptoms remain severe despite other treatments.

Some procedures aim to remove or treat affected uterine tissue while preserving the uterus.

A hysterectomy, which removes the uterus, is the definitive surgical treatment for adenomyosis, but it is major surgery and means pregnancy is no longer possible.

The appropriate option depends heavily on symptoms and fertility plans.

Can adenomyosis affect fertility?

Adenomyosis has been associated with difficulty becoming pregnant and with some pregnancy complications.

That doesnโ€™t mean pregnancy is impossible if you have adenomyosis.

If youโ€™re trying to conceive, tell your doctor before making treatment decisions because some treatments suppress ovulation or prevent pregnancy while theyโ€™re being used and some surgical procedures can affect fertility.

When should you see a doctor?

Talk with your GP if:

  • your periods are becoming increasingly painful
  • your periods are very heavy or prolonged
  • you regularly pass large clots
  • pelvic pain occurs outside your period
  • you experience pain during sex
  • your symptoms interfere with work, exercise, sleep or everyday activities
  • youโ€™re having difficulty becoming pregnant
  • you feel tired, dizzy, weak or short of breath and may have iron deficiency

Painful periods are common, but pain that regularly stops you living your normal life deserves investigation.

Frequently asked questions

Is adenomyosis the same as endometriosis?

No. Adenomyosis involves endometrial-like tissue within the muscular wall of the uterus, while endometriosis involves similar tissue growing outside the uterus. You can have both conditions at the same time.

Is adenomyosis cancer?

No. Adenomyosis is a benign condition and isnโ€™t uterine cancer.

Can adenomyosis cause heavy periods?

Yes. Heavy or prolonged periods are among the most common symptoms of adenomyosis and can lead to iron deficiency or anaemia.

Can adenomyosis cause large blood clots?

It can contribute indirectly because adenomyosis may cause heavy menstrual bleeding. Heavier flow makes larger visible clots more likely, but blood clots alone donโ€™t diagnose adenomyosis.

Does adenomyosis show on an ultrasound?

Often it can. Modern pelvic and transvaginal ultrasound can identify features suggesting adenomyosis. MRI may sometimes be used when the diagnosis remains uncertain or more detailed imaging is needed.

Does adenomyosis get worse with age?

Symptoms can change over time and may be particularly troublesome during the later reproductive years. Adenomyosis is hormone-responsive and symptoms often improve after menopause, although any new bleeding after menopause still needs assessment.

Can adenomyosis be cured?

Medicines can reduce pain and bleeding but donโ€™t remove adenomyosis from the uterine muscle. Hysterectomy is considered the definitive treatment because it removes the uterus, but it is not appropriate or necessary for everyone.

You donโ€™t have to accept debilitating periods as normal

Adenomyosis can be difficult because its symptoms overlap with several other pelvic health conditions and some people spend years assuming that severe pain or heavy bleeding is simply what their period is like.

If your period regularly keeps you home, wakes you at night, causes flooding or large clots or leaves you exhausted from blood loss, it deserves attention.

There are treatment options, and you donโ€™t need to wait until symptoms become unbearable before asking for help.

Related reading

Sources and further reading

This article provides general educational information and isnโ€™t a substitute for individual medical advice.