Adenomyosis: symptoms, diagnosis and treatment

Adenomyosis occurs when tissue resembling the womb lining grows within the muscular wall of the womb.

This tissue responds to hormonal changes during the menstrual cycle and can make the womb enlarged, tender or painful. Adenomyosis is benign and is different from endometriosis, although both conditions can occur together.

Adenomyosis commonly presents with heavy periods, painful periods and pelvic pain. Some people also experience a feeling of pressure or fullness low in the abdomen, pain during sex, or tiredness associated with ongoing blood loss. Others have no noticeable symptoms.

Seek prompt medical care for bleeding that soaks through period protection rapidly, fainting, severe worsening pain, shortness of breath or possible pregnancy with pain or bleeding.

The exact process is not fully understood. The boundary between the womb lining and muscle may become disrupted, allowing lining-like tissue to grow into the muscle. Hormonal signals, inflammation and changes after pregnancy or procedures involving the womb may contribute in some people.

Symptoms can remain mild, fluctuate with menstrual cycles or become more disruptive over time. They often settle after menopause as reproductive hormone levels fall. A change in bleeding pattern still deserves assessment because other conditions can cause similar symptoms.

Adenomyosis is more often recognised in people who have given birth or had surgery involving the womb, but it can occur without either history. Being in the later reproductive years may also be associated. These factors do not prove that someone has the condition.

Assessment begins with the bleeding and pain pattern, pregnancy plans, medicines and examination findings. A blood test may check for anaemia. Pelvic ultrasound is commonly used to look at the womb and exclude other explanations; magnetic resonance imaging may clarify uncertain findings. Similar symptoms can come from fibroids, endometriosis or other pelvic conditions.

Treatment depends on bleeding, pain, other health conditions and whether future pregnancy matters. Anti-inflammatory pain medicines may ease cramps. Tranexamic acid can reduce heavy bleeding, while hormonal treatments such as a hormonal coil can reduce bleeding and pain for some people.

Procedures may be considered when symptoms remain severe. Uterine artery embolisation reduces blood supply to affected tissue. Endometrial ablation treats the womb lining but may not address disease deep in the muscle. Hysterectomy removes the womb and is the definitive surgical treatment; it ends the ability to carry a pregnancy.

A period and pain diary can reveal patterns and show whether treatment is helping. Plan access to period products on heavier days, use heat if soothing, and pace activity during painful episodes. Persistent fatigue, dizziness or reduced exercise tolerance may indicate anaemia and should be discussed with a clinician.

Repeated heavy bleeding can cause iron-deficiency anaemia, leading to fatigue, palpitations or breathlessness. Chronic pain may disturb sleep, work, exercise, relationships and sexual wellbeing. Fertility questions need individual assessment because adenomyosis can coexist with other conditions that affect conception or pregnancy.

There is no established way to prevent adenomyosis. Early evaluation of troublesome bleeding or pain can identify anaemia, rule out other causes and open a discussion about symptom control before daily life is heavily affected.

A gynaecologist can coordinate imaging and treatment. Seek a clinician experienced in heavy menstrual bleeding and pelvic pain if symptoms persist, and a fertility specialist when pregnancy planning is a concern. Bring your cycle diary, medicine list, prior scan reports and treatment preferences.