Adenomyosis: symptoms, diagnosis and what helps
Adenomyosis is a condition where tissue like the lining of the uterus grows into the uterus's muscular wall. It can cause heavy, long, painful periods, pelvic pressure or bloating, and pain during sex, though some people have no symptoms. It's most often found in people in their 40s, but it can affect younger people too. Treatments range from hormonal options to surgery.
What adenomyosis is
The uterus has an inner lining (the endometrium), which builds up and sheds each cycle, and a thick muscular wall (the myometrium). In adenomyosis, endometrial-like tissue grows into the muscle wall. It still responds to your cycle's hormones, so it can swell and bleed inside the muscle each month, making the uterus bulky, tender and more crampy.
It's not cancer and isn't dangerous in itself, but it can have a big effect on quality of life. The exact cause isn't known. Cleveland Clinic notes it's most common between ages 40 and 50 and in people who have had surgery on the uterus, such as fibroid removal, a D&C or a caesarean, but it's increasingly recognized in younger people too, including some teens with very painful periods.
Symptoms
- Heavy periods, sometimes with clots or flooding
- Long periods, lasting more than 7 days
- Severe cramps that get worse over the years
- Pelvic pain or pressure between periods, or a feeling of fullness and bloating in the lower belly
- Pain during or after sex
- Spotting between periods
- Tiredness, often from iron deficiency caused by heavy bleeding
- No symptoms at all, in some people; it may only show up on a scan
Adenomyosis vs endometriosis vs fibroids
| Adenomyosis | Endometriosis | Fibroids | |
|---|---|---|---|
| Where | Inside the muscle wall of the uterus | Outside the uterus, usually in the pelvis | Growths of muscle tissue in or on the uterus |
| Main symptoms | Heavy, painful periods; bulky, tender uterus | Pelvic pain, painful periods, pain with sex or bowel movements | Heavy periods, pressure, frequent peeing |
| Typical age | Most often 40s, but any age | Often from the teens and 20s | 30s to 50s |
| Found by | Ultrasound or MRI | Laparoscopy, sometimes scans | Ultrasound |
They often happen together, which can make symptoms harder to untangle. See our guide to endometriosis.
How it's diagnosed
The NHS notes it can take a long time to diagnose adenomyosis. A doctor will ask about your periods and pain and may examine you; the uterus can feel enlarged or tender. Transvaginal ultrasound and MRI can now often show adenomyosis, so surgery is rarely needed just to diagnose it. You may also have a blood test for anemia.
Treatment options
- Pain relief: anti-inflammatory painkillers such as ibuprofen or naproxen, started just before or at the start of your period.
- Tranexamic acid: a non-hormonal tablet taken during your period to reduce heavy bleeding.
- Hormonal treatments: the hormonal IUS (coil), the combined pill or progestogen tablets can make periods lighter and less painful, or stop them.
- Other hormone medicines that lower estrogen for a time, usually short term.
- Procedures: uterine artery embolization or endometrial ablation in some cases.
- Hysterectomy: the only permanent cure, for people who've finished having children and whose symptoms aren't controlled.
- Iron if you're low.
Adenomyosis usually improves after menopause, when estrogen falls.
Living with it: pain, energy and mood
Heavy, painful periods every month wear you down. Low iron saps energy and concentration, pain disrupts sleep, and planning life around your period is stressful. Low mood and anxiety are understandable responses, and worth mentioning to your doctor. Tracking helps here too: knowing which days are likely to be heaviest and most painful lets you plan rest, cover and pain relief ahead of time. See heavy periods and period cramps.
Lulu predicts your next period from your own cycles, and lets you log flow, cramps and backache as bunny drawings alongside your mood, building a clear picture to share with your doctor.
When to see a doctor
See a doctor if your periods are getting heavier, longer or more painful; if you change a pad or tampon every 1 to 2 hours, pass large clots or bleed for more than 7 days; if you have pain during or after sex; if you've felt bloated for about 3 weeks; if you bleed between periods or after sex; or if you feel tired, breathless or dizzy. Get urgent help for very heavy bleeding with fainting.
Frequently asked questions
What does adenomyosis pain feel like?
Often deep, crampy pelvic pain that's worse during periods, sometimes with a heavy, dragging or pressured feeling in the lower belly.
Can adenomyosis be seen on an ultrasound?
Often, yes. A transvaginal ultrasound or MRI can show signs of adenomyosis, though mild cases can be missed.
Does adenomyosis go away?
It usually improves after menopause. Before then, treatments can control symptoms; hysterectomy is the only permanent cure.
Can you get pregnant with adenomyosis?
Many people do. It may be linked to a higher risk of some pregnancy complications, so mention it to your doctor.
Sources
This page is for information only and isn鈥檛 medical advice. If something worries you, please talk to a doctor.
Keep reading
Endometriosis: signs worth discussing with a doctorEndometriosis explained kindly: the symptoms that are more than bad cramps, why diagnosis takes years, how tracking your pain can help, and treatment options.
Heavy periods: what counts as heavy and what helpsHow to tell if you have heavy periods: soaking a pad every hour or two, clots, bleeding over 7 days. Causes, treatments that work, and when to get help.Period cramps: why they happen and what actually helpsPeriod cramps explained kindly: why your uterus cramps, how long it lasts, what really helps (timing matters) and the signs that need a doctor.
Periods in your 40s: what changes and whyPeriods in your 40s often get shorter, heavier, closer together or more irregular. Why it happens, what's normal, what helps, and when to see a doctor.Period calculator: when is my next period?Free period calculator: enter the first day of your last period and your cycle length to see your next 6 periods. Private, instant, nothing is stored.