Adenomyosis
Adenomyosis is a common condition where tissue similar to the lining of the womb grows into the muscle of the womb. This can cause heavy periods, painful cramps, pelvic pain and bloating. Although the condition can affect daily life, effective treatments are available to help manage symptoms and improve quality of life.
Commonality
Adenomyosis is a common gynaecological condition, affecting around 1 in 10 women. It is most often diagnosed in women in their 30s and 40s, but it can occur at any reproductive age. Because its symptoms can resemble other conditions such as fibroids or endometriosis, it is sometimes overlooked or misdiagnosed.
Causes
The exact cause of adenomyosis is not fully understood. However, several factors are thought to contribute, including hormonal influences such as oestrogen, inflammation after childbirth, previous uterine surgery (including caesarean section), and developmental changes in the uterus before birth.
Certain factors may also increase the likelihood of developing adenomyosis, including being over the age of 40, having had multiple pregnancies, a family history of adenomyosis, and a history of heavy or painful periods.
Adenomyosis is a medical condition and is not caused by lifestyle choices.
Symptoms
Common symptoms of adenomyosis include:
Heavy or prolonged periods
Severe menstrual cramps
Chronic pelvic pain or pressure
Bloating
Pain during intercourse
Fatigue around menstruation
Urinary frequency caused by pressure on the bladder
Symptoms can range from mild to severe and may worsen over time.
Effects on Fertility
Adenomyosis does not always affect fertility, but in some women it may make it more difficult to conceive or increase the risk of miscarriage. Women who are trying for pregnancy and have symptoms of adenomyosis may benefit from early specialist assessment. With appropriate treatment and fertility support where needed, many women with adenomyosis go on to have successful pregnancies.
Diagnosis
Adenomyosis is diagnosed using a combination of symptom assessment, pelvic examination and specialist imaging.
Diagnosis may include:
Review of menstrual symptoms, pelvic pain and medical history
Pelvic examination to assess for a tender or enlarged uterus
Specialist transvaginal ultrasound to identify features of adenomyosis
MRI scanning in some cases for further assessment
Modern imaging techniques now allow most cases of adenomyosis to be diagnosed without surgery.
Treatments
Treatment for adenomyosis depends on symptom severity, age, fertility plans and individual preferences. Management may include medical treatment or minimally invasive surgery.
Medical treatments may include:
Hormonal contraception
Mirena coil (levonorgestrel intrauterine system)
Hormonal suppression therapies
Anti-inflammatory pain relief such as mefenamic acid
If symptoms remain severe despite medication, surgical treatment may be considered. Options can include:
Laparoscopic (keyhole) surgery
Robotic-assisted surgery
Fertility-preserving procedures where appropriate
Hysterectomy in selected cases where fertility is no longer required
Treatment aims to reduce pain, control heavy bleeding and improve quality of life.
Ongoing Care
Adenomyosis often requires ongoing management rather than a single treatment. Regular follow-up can help monitor symptoms and ensure treatment remains effective over time.
Ongoing care may include:
Review with a specialist gynaecologist
Monitoring pain, bleeding and other symptoms
Adjusting medications when needed
Further imaging or assessment if symptoms change
Reviewing fertility plans and treatment goals over time
Individualised care helps ensure treatment continues to meet each patient’s needs.
Living with the Condition
Living with adenomyosis can be challenging, as symptoms such as chronic pain and heavy bleeding may affect work, relationships and overall wellbeing. Fatigue and ongoing pelvic discomfort can also have a significant impact on daily life.
However, with accurate diagnosis and appropriate treatment, many women experience significant improvement in their symptoms and quality of life. Ongoing care and regular follow-up can help ensure treatment continues to meet individual needs.
When to See a Specialist
You may benefit from seeing a specialist if you experience:
Heavy periods that interfere with daily life
Severe menstrual pain
Chronic pelvic pain or pressure
Pain during intercourse
Persistent fatigue around menstruation
Early specialist assessment can help identify the cause of symptoms, confirm a diagnosis and allow more effective treatment to begin sooner.