Adenomyosis
Learn about adenomyosis -- when endometrial tissue grows into the uterine wall
Overview
Adenomyosis is a condition where endometrial-like tissue (the tissue that normally lines the uterus) grows into the muscular wall of the uterus (myometrium). This causes the uterus to enlarge, become tender, and produce heavy, painful periods. While distinct from endometriosis, the two conditions commonly co-occur -- up to 50% of individuals with adenomyosis also have endometriosis.
Diagnosis has historically required hysterectomy for definitive confirmation, but advances in transvaginal ultrasound and MRI have dramatically improved non-invasive detection. Characteristic imaging findings include an enlarged, globular uterus, asymmetric myometrial thickening, and small cysts within the muscle wall.
Adenomyosis is often underdiagnosed, with many individuals being told that heavy, painful periods are "normal." Symptoms frequently worsen over time and can be just as debilitating as endometriosis. Treatment ranges from hormonal management (with the LNG-IUD being first-line for bleeding control) to surgical options for those who have completed childbearing.
Symptoms
Heavy menstrual bleeding
Menorrhagia with prolonged, heavy flow often requiring frequent pad/tampon changes and sometimes causing anemia.
Severe period pain
Intense dysmenorrhea that often worsens over time as the condition progresses.
Chronic pelvic pain
Persistent lower abdominal or pelvic pain that may extend beyond menstruation.
Painful intercourse
Deep pain during sex due to an enlarged, tender uterus.
Uterine tenderness
A tender, boggy uterus on examination, sometimes with noticeable enlargement.
Bloating and pressure
A sense of pelvic fullness or bloating, especially around menstruation, related to uterine enlargement.
Passing large blood clots
Frequent passage of large clots during heavy menstrual flow.
Treatment Options
LNG-IUD (Mirena)
First-line treatment for bleeding control. Delivers progesterone directly to the uterus, thinning the endometrial tissue and reducing flow.
Hormonal therapy
Continuous oral contraceptives, dienogest, or GnRH agonists/antagonists to suppress endometrial growth and reduce symptoms.
Tranexamic acid
Non-hormonal medication taken during heavy bleeding days to reduce menstrual blood loss.
Hysterectomy
Definitive treatment when fertility is no longer desired and conservative approaches have failed.
Conservative surgery
Adenomyomectomy or focal excision for those wishing to preserve fertility, though techniques are less well-studied.
Pain management
NSAIDs for symptomatic relief, along with heat therapy and pelvic floor physical therapy for associated muscle tension.
Frequently Asked Questions
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Important Notice
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for medical decisions specific to your situation.