What is Adenomyosis?

What is adenomyosis?

Adenomyosis (ad-uh-no-my-o-sis) is a condition where cells similar to those in the lining of the womb, also called the uterus, grow into the muscle of the womb wall. It responds to menstrual cycle hormones and affects around 10% of women and people assigned female at birth. Some people have adenomyosis or endometriosis on their own, but it is common to have both.

It can be found anywhere within the wall of the womb, resulting in inflammation and pain. It can also cause the womb wall to thicken making it larger in size.

Diffuse adenomyosis is when adenomyosis is found throughout the whole of the womb wall

Adenomyoma is when adenomyosis is found in a specific area of the womb wall, causing a lump in the muscle.

It’s important to know that adenomyosis is not contagious, is not an infection and is not a cancer.

What is the difference between endometriosis and adenomyosis?

The main difference is the location of the endometrial-like cells. In adenomyosis, they are found in the muscular wall of the womb; in endometriosis, they are found outside the womb on the lining of the pelvis and may occur in the ovaries and involve other pelvic organs, such as the bowel or bladder.

Adenomyosis is usually diagnosed later than endometriosis, most often in people in their late 30s to 40s, although it can also affect teenagers and people in their 20s. It has also been reported that whereas endometriosis can cause pain during or after sex, those with adenomyosis more often find that it occurs afterwards and can last for several hours.

What are the symptoms?

The symptoms of adenomyosis are very similar to those of endometriosis. They include:

• Severe period pain that interferes with daily life
• Heavy periods
• Periods that last longer than seven days
• A dragging or heavy sensation within the pelvis. This can happen at any time in your cycle, not just during your period.
• Bloating. This can happen at any time in your cycle, not just during your period.
• Pain during or after sex
• Difficulties in getting pregnant

How is it diagnosed?

At your initial visit to a GP, it would be helpful to take a pain and symptoms diary detailing how long your periods last, how painful they are, how heavy they are, and whether you have pain during or after sex and how long it lasts.

A GP may give you a vaginal examination to assess the size of the womb and check the cervix (neck of the womb) and vaginal walls (you may request a female GP if you feel more comfortable with that). 

An ultrasound or magnetic resonance imaging (MRI) scan can, in some cases, detect adenomyosis. They can show a thickening of the myometrium (the muscular layer of the womb) and an uneven pattern in the tissue can also sometimes be seen, which can be in keeping with adenomyosis. In other cases, there may be subtle changes, so a diagnosis is not always possible with a scan.

How is it treated?

Medication

Pain relief such as paracetamol and anti-inflammatory painkillers, like ibuprofen, naproxen and mefenamic acid

Tranexamic acid can help to reduce bleeding during a period. It works on clotting and is usually only taken for four days from the start of a period.

Hormonal contraceptives such as contraceptive pills or patches and progestogens, including the intrauterine system (IUS) also known as the coil - a device that releases low doses of progestogen inside the uterus.

GnRH (gonadotrophin-releasing hormone) analogues medications. These drugs stop the ovaries from being stimulated, stopping the production of oestrogen and causing temporary medically induced menopause.

It can be several months before they start to offer relief from symptoms, so stay in touch with your GP if you try them.

Surgery

If your adenomyosis is localized and formed a lump you may have surgery to cut out the adenomyosis.

In some cases hysterectomy is recommended. This is only suitable if a family is complete or there are no plans for pregnancy in the future. While a hysterectomy is a successful and curative treatment for the majority of people, pain symptoms can remain for some, and it’s thought that this is because of the way the nervous system responds when chronic pain is experienced.

Does it affect fertility?

Many with adenomyosis will be able to get pregnant naturally and others may struggle to get pregnant. We do know that adenomyosis can affect fertility and increase the risk of miscarriage.

If you are struggling with your fertility, please discuss this with your GP as referral to a fertility specialist may help.

Do the symptoms go away after menopause?

The symptoms should improve and go away as menstruation stops because the cells are no longer responding to monthly hormonal fluctuations. Some may continue to experience heaviness or discomfort as the enlarged womb is still there.