Adenomyosis

What is adenomyosis?

Adenomyosis (pronounced “add-en-o-my-OH-sis”) is when tissue similar to the lining of your uterus (endometrium) starts to grow into the muscle wall of your uterus (myometrium). It causes your uterus to thicken and enlarge — sometimes, up to double or triple its usual size. Adenomyosis can cause painful periods, heavy or prolonged menstrual bleeding with clotting and abdominal/pelvic pain.

How common is adenomyosis?

Many women and people assigned female at birth (AFAB) aren’t aware they have adenomyosis because the condition doesn’t always cause symptoms. The exact prevalence of adenomyosis is unknown. However, researchers know it’s more common in people who:

• Have had a procedure on their uterus.
• Are older than 40.

Approximately 2% to 5% of adolescents with severely painful cycles have adenomyosis.

What are the signs of adenomyosis?

About 1 in 3 people with adenomyosis don’t have signs or symptoms. Some people experience:

• Painful menstrual cramps (dysmenorrhea).
• Heavy menstrual bleeding (menorrhagia).
• Abnormal menstruation.
• Pelvic pain with or without severe cramping.
• Painful intercourse (dyspareunia).
• Infertility.
• Enlarged uterus.
• Bloating or fullness in your belly (adenomyosis belly).

What causes adenomyosis?

Researchers don’t know why some people develop adenomyosis or what causes it. However, some research suggests hormones, genetics or inflammation/trauma may contribute to adenomyosis.

What are the risk factors for this condition?

Adenomyosis most commonly occurs in women and people AFAB who:

• Are between the ages of 40 and 50.
• Have given birth at least once.
• Have had prior uterine surgeries such as uterine fibroid removal or dilation and curettage (D&C).
• Have endometriosis.

However, providers are diagnosing adenomyosis more frequently in people in their 30s who have abnormal vaginal bleeding or painful periods.

What are the complications of adenomyosis?

The symptoms of adenomyosis tend to get worse over time. Heavy menstrual bleeding from adenomyosis increases your risk of anemia. Anemia occurs when your body doesn’t have enough iron-rich red blood cells. Anemia may cause you to feel fatigued or cold.

Can adenomyosis become cancerous?

No. Adenomyosis itself doesn’t cause cancer or lead to cancer.

How is adenomyosis diagnosed?

Healthcare providers often suspect adenomyosis based on your symptoms and one or more of these tests:

• Pelvic exam: During a pelvic exam, your provider may notice that your uterus has gotten larger, softer or is painful to the touch.
• Ultrasound: A transvaginal ultrasound uses sound waves to produce images of your pelvic organs. These images can sometimes show thickening of your uterine wall.
• Imaging scans: Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of your uterus.

Your provider may rule out more serious conditions with a biopsy. During a biopsy, your provider collects tissue and tests it for signs of more serious diseases.

How is adenomyosis managed or treated?

Because the hormone estrogen promotes endometrial tissue growth, adenomyosis symptoms often go away after menopause. In the meantime, these treatments can ease pain, and help with heavy bleeding and other symptoms:

• Pain medications: Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®), ease cramping.
• Hormonal medications: Certain hormonal medications can help with menstruation and abnormal bleeding. Options include birth control pills, Depo-Provera® injection and hormonal intrauterine devices (IUD), such as Mirena®.
• Nonhormonal medication: Medications like tranexamic acid can reduce the amount of vaginal bleeding.
• Adenomyomectomy: Surgery to remove adenomyosis from your uterine muscle. This procedure is similar to a myomectomy, which removes uterine fibroids.
• Hysterectomy: This surgery removes your uterus. After a hysterectomy, you won’t have a menstrual cycle or be able to get pregnant.

What happens if adenomyosis is left untreated?

Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo can’t implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain.

How can I prevent adenomyosis?

As the cause of adenomyosis isn’t well understood, healthcare providers don’t know of anything you can do to prevent it.

What can I expect if I have this condition?

Many people who experience life-disrupting symptoms from adenomyosis find relief through treatment. After menopause, symptoms should go away. But you may still have an enlarged uterus.

How does adenomyosis affect pregnancy?

Adenomyosis tends to affect women who have had at least one child. However, the condition may make it difficult to conceive for the first time or to have another child. Once you’re pregnant, there’s an increased risk of:

• Miscarriage.
• Premature labor.

When should I call a healthcare provider?

You should call your healthcare provider if you experience:

• Extremely heavy periods.
• Severely painful cramps.
• Painful intercourse.
• A feeling of fullness or heaviness in your abdomen.

What questions should I ask my healthcare provider?

If you have adenomyosis, you may want to ask your healthcare provider:

• Why did I get adenomyosis?
• What’s the best treatment for me?
• Should I use a different birth control method?
• Will I be able to get pregnant?
• Should I look out for signs of complications?

What is the difference between adenomyosis and endometriosis?

Adenomyosis and endometriosis are disorders that involve endometrial-like tissue. Both conditions can be painful. Adenomyosis is more likely to cause heavy menstrual bleeding. The difference between these conditions is where the tissue grows.

• Adenomyosis: Endometrial-like tissue grows into the muscle of your uterus.
• Endometriosis: Endometrial-like tissue grows outside your uterus in places like your ovaries or fallopian tubes.

Is adenomyosis a serious condition?

Adenomyosis doesn’t usually cause any serious complications. It can lead to difficulty conceiving or miscarriage. The symptoms it causes can disrupt your daily life. Don’t be afraid to talk to your healthcare provider about ways you can feel better.

What are the dangers of adenomyosis?

There aren’t any life-threatening dangers of adenomyosis. It can cause heavy bleeding, prolonged menstrual bleeding and pelvic pain.

A note from Cleveland Clinic

You may not know you have adenomyosis. The condition doesn’t always cause symptoms. When symptoms occur, such as heavy periods, cramping or painful intercourse, they can disrupt your life. Talk to your healthcare provider about ways to ease symptoms. Certain medications can help. If you don’t plan to have children, a hysterectomy to remove your uterus can cure the condition. Symptoms tend to go away after menopause.