Adenomyosis is a medical condition that affects the uterus. It occurs when the tissue that lines the uterus, known as endometrial tissue, grows into the muscular wall of the uterus, causing it to become enlarged and painful. People with adenomyosis may experience abnormal uterine bleeding, severe menstrual cramps, and pelvic pain. The exact cause of adenomyosis is not clear. Adenomyosis is most commonly diagnosed in individuals assigned female at birth (AFAB) between the ages of 35 and 50 who have had children and may be diagnosed using a physical exam, pelvic ultrasound, or MRI and can be treated with pain management medications, hormonal therapies, and surgery.
Causes of adenomyosis
The causes of adenomyosis are yet to be fully understood; however, several researchers over the last decade have tried to elucidate its origin.
The recent theory states that it is due to the invagination of endometrial tissue in the intersection between the endometrium and the myometrium (lining of the uterus and its muscular wall). This is called the junctional zone and is very sensitive to hormone fluctuations, mainly oestrogen. Oestrogen stimulates the growth of endometrial tissue, which sheds during menstruation. In adenomyosis, this tissue grows into the muscular wall of the uterus, causing it to become thickened and tender.1
Adenomyosis is more common in AFABs who have had children, especially those who have had a cesarean delivery or other uterine surgery. This is believed to be caused by embryonic cells that may have migrated into the myometrium. It may also be associated with other conditions that affect the uterus, such as endometriosis or fibroids. Some studies have suggested that chronic inflammation may also play a role in the development of adenomyosis.1
Signs and symptoms of adenomyosis
Adenomyosis can cause a range of symptoms, which may vary in severity. Some AFABs with adenomyosis may experience no symptoms at all, while others may experience significant discomfort and pain.
The most commonly experienced symptoms by AFABs include:1
- Abnormal uterine bleeding
- Dysmenorrhea (strong menstrual cramps)
- Pelvic pain
- Pain during sex
Other possible symptoms of adenomyosis include:1
- Mood changes
- Digestive issues such as bloating and constipation
It is important to note that many of these symptoms are also associated with other conditions, such as endometriosis and fibroids.2 Therefore, a proper diagnosis by a medical professional is essential for effective treatment.
Diagnosis involves a combination of medical history, physical tests, and imaging tests.
- A medical history and physical exam are usually carried out first to check pelvic activity and for abnormal uterine bleeding symptoms. The physician then performs a bimanual exam to check if the uterus is enlarged or tender
- Imaging techniques include a transvaginal ultrasound to obtain images of the whole pelvic area. An MRI can also be performed for clearer results, as it shows soft tissue that has enlarged or thickened1
In severe cases, a biopsy, which is a sample of the uterus, is taken for further investigation.
Management and treatment for adenomyosis
Some AFABs may not require treatment if their symptoms are mild, while others may require more aggressive interventions. Here are some possible management and treatment options for adenomyosis:3
- Pain management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help to relieve menstrual cramps and pelvic pain associated with adenomyosis
- Hormonal therapy: Hormonal medications such as birth control pills, progestin-only therapy, or a levonorgestrel intrauterine device (IUD) can help to reduce heavy bleeding and relieve pain
- Endometrial ablation: This procedure involves destroying the endometrial tissue to reduce bleeding and pain
- Hysterectomy: In severe cases, a hysterectomy may be recommended to remove the uterus and permanently eliminate symptoms. This is typically only recommended for AFABs who have completed childbearing or do not wish to have children
Aside from speaking to a healthcare provider to determine the best course of action, there are some home remedies and lifestyle changes which are possible:
- Using heat on the belly to reduce pelvic pain
- Taking a warm bath
- Diet changes, avoiding inflammatory foods
- Stress management
- Light exercise
Some AFABs might decide to undergo the removal of the uterus to stop the abnormal bleeding after bearing children. This is known as hysteroscopy and is offered in the most advanced cases.
Even though the cause of adenomyosis is not fully understood, there are certain factors that can increase the prevalence of the condition:4
- Previous childbirth or abortion
- Irregular hormonal cycles, particularly with estrogen
- Age: more common in AFABs in their 40s onwards
- Having abnormal endometrial tissue growing elsewhere, i.e. suffering from endometriosis
Adenomyosis can cause a range of complications, including
- Severe menstrual pain and cramping
- Heavy menstrual bleeding
- Anaemia due to blood loss
- Chronic pelvic pain
- Painful intercourse
- Infertility or difficulty getting pregnant
- Higher risk of miscarriage and preterm birth during pregnancy
- Reduced quality of life due to pain
While adenomyosis itself is not life-threatening, it can have a significant impact on an AFAB's physical and emotional well-being.
How can I prevent adenomyosis?
Currently, there is no known way to prevent adenomyosis. However, seeking prompt medical attention and managing risk factors such as hormonal imbalances and previous uterine surgery may help to reduce the risk of developing adenomyosis.
How common is adenomyosis?
Estimates suggest that it may affect up to 20-35% of AFABs of reproductive age, and it is most commonly diagnosed in AFABs in their 35s and 50s who have had children. However, it is possible that adenomyosis is underdiagnosed, as its symptoms can be similar to other gynaecological conditions such as endometriosis and uterine fibroids.
When should I see a doctor?
You should seek medical attention if you experience abnormal uterine bleeding and heavy bleeding, which causes debilitating pelvic pain and menstrual cramps. It is important to rule out other underlying conditions associated with endometrial tissue growth, such as endometriosis. Therefore it is important to see a doctor for an accurate diagnosis.
Adenomyosis is a condition in which the endometrial tissue that normally lines the uterus grows into the muscular wall of the uterus, causing pain, abnormal uterine bleeding, heavy bleeding and menstrual concerns. It is most commonly diagnosed in AFABs in their 35s and 50s who have had children. It is very difficult to diagnose as it shares symptoms with endometriosis and uterine fibroids. However, it is crucial to get medical attention as it is a very debilitating condition that can present complications if left untreated. Treatment depends on individual concerns and can be life-changing for AFABs who have real physical and emotional distress from adenomyosis. So please visit your doctor if you experience any of the symptoms of adenomyosis.
- Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res [Internet]. 2019 Mar 13 [cited 2023 Oct 30];8:F1000 Faculty Rev-283. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419978/
- Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertility and Sterility [Internet]. 2018 Mar [cited 2023 Oct 30];109(3):380-388.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0015028218300062
- Pontis A, D’Alterio MN, Pirarba S, De Angelis C, Tinelli R, Angioni S. Adenomyosis: a systematic review of medical treatment. Gynecological Endocrinology [Internet]. 2016 Sep 1 [cited 2023 Oct 30];32(9):696–700. Available from: https://www.tandfonline.com/doi/full/10.1080/09513590.2016.1197200
- Shrestha A. Risk factors for adenomyosis. Journal of Nepal Health Research Council [Internet]. 2012 [cited 2023 Oct 30]; Available from: http://www.jnhrc.com.np/index.php/jnhrc/article/view/338