Adenomyosis

Understanding Adenomyosis

Adenomyosis is a benign gynecologic condition in which tissue similar to the lining of the uterus (endometrium) is found within the muscular wall of the uterus (myometrium). This can cause the uterine muscle to become thicker, leading to an enlarged, rounded uterus and contributing to painful or heavy menstrual periods.

Common symptoms of adenomyosis may include:

Heavy or prolonged menstrual bleeding
Painful menstrual cramps (dysmenorrhea), which may become progressively worse over time
Chronic pelvic pain or pressure
Pain with intercourse
An enlarged or tender uterus

Some patients with adenomyosis have very few symptoms or may not experience any symptoms at all.

Fortunately, several treatment options are available to help manage symptoms. Treatment depends on the severity of your symptoms, your reproductive goals, and your individual preferences.

Diagnosing Adenomyosis

Adenomyosis is often suspected based on your symptoms, pelvic examination, and imaging findings. Pelvic ultrasound is typically the first test used to evaluate for adenomyosis.

Pelvic Ultrasound

A transvaginal ultrasound may show characteristic changes in the muscular wall of the uterus (myometrium), including:

Heterogeneous myometrium: An uneven or patchy appearance of the uterine muscle.
Globular enlargement: The uterus may appear enlarged and more rounded than usual.
Asymmetric thickening: One uterine wall may be thicker than the other.
Other findings: Small cysts within the uterine muscle or characteristic areas of shadowing.

Not every patient will have all of these findings, and ultrasound findings alone may not always provide a definitive diagnosis.

Additional Evaluation

MRI may occasionally be recommended when ultrasound findings are unclear or additional detail is needed.

Historically, adenomyosis was definitively diagnosed by examining uterine tissue after hysterectomy. However, surgery is not necessary to make a clinical diagnosis, and many patients can be diagnosed and treated based on their symptoms and imaging findings.

An endometrial biopsy does not typically diagnose adenomyosis because it samples the uterine lining rather than the muscular wall.

Adenomyosis vs. Endometriosis

Adenomyosis and endometriosis are related but different conditions. Adenomyosis involves endometrial-like tissue within the muscular wall of the uterus, while endometriosis involves similar tissue located outside the uterus. Both conditions can contribute to pelvic pain and painful periods, and they can occur together.

→ Learn more about Endometriosis

Managing Adenomyosis

Treatment for adenomyosis focuses on reducing heavy menstrual bleeding, relieving pelvic pain, and improving quality of life. Not everyone with adenomyosis requires treatment, particularly if symptoms are mild or absent. The best approach depends on your symptoms, medical history, reproductive goals, and personal preferences.

Medications & Hormonal Treatments

Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen may help relieve menstrual cramps and reduce menstrual bleeding.
Hormonal contraception: Birth control pills, patches, vaginal rings, or certain progestin-only methods can help reduce bleeding and menstrual pain.
Hormonal IUD (Mirena): Often an effective option for managing heavy bleeding and painful periods associated with adenomyosis. Some patients experience significantly lighter periods or stop having periods altogether.
Oral progestins: Medications such as norethindrone acetate (Aygestin) may help suppress bleeding and improve pelvic pain.
Other hormonal therapies: Medications that temporarily suppress ovarian hormone production may be considered for more severe symptoms or when other treatments have been unsuccessful.

Surgical Management

Hysterectomy (removal of the uterus) is the definitive treatment for adenomyosis. It may be considered for patients with significant symptoms who have completed childbearing and have not achieved adequate relief with other treatments, or who prefer a permanent solution. The ovaries do not necessarily need to be removed during hysterectomy, allowing natural hormone production to continue until menopause.

Choosing the Right Treatment

Adenomyosis is a benign condition, and treatment is not always necessary. The goal is to find an approach that adequately controls your symptoms while aligning with your individual needs and future pregnancy plans.

For more information about managing heavy menstrual bleeding, including medications and surgical options, visit my Heavy Menstrual Bleeding page.