Your guide to understanding adenomyosis

Adenomyosis affects one in 10 women. It is a condition that is most common in women who have had children or aged 40 to 50. Despite this, it is an often misunderstood and misdiagnosed condition. Adenomyosis can be mistaken for interstitial cystitis, thyroid disorders and endometriosis due to the similarities in symptoms with these conditions.

What is adenomyosis?

Adenomyosis is a long-term condition that affects significant numbers of women. It occurs when cells similar to those that line the womb, called the endometrium, are found in the muscle wall of the womb, called the myometrium.

It is most common in women who are aged in their 40s and 50s and in those who have had children. But the condition can occur in any woman who still has a menstrual cycle.

Adenomyosis is not spread between people and it is not cancerous. The exact cause of adenomyosis is still not known, so there is no method that will prevent it from occurring.

The condition can affect many areas of a woman’s life, such as emotional wellbeing, relationships and daily routines.

Endometriosis and adenomyosis also have similar symptoms, so it is important that you get an accurate diagnosis. This can take time to eliminate other conditions.

What causes adenomyosis?

The exact cause of adenomyosis is still not known. However, several theories have been suggested as being the cause. These include:

• The uterine wall has extra tissue from birth and this then grows during adulthood
• Abnormal tissues grow from the endometrial cells into the muscles of the womb
• Stem cells in the uterine muscle wall cause the condition
• Inflammation in the womb, which often happens after childbirth

It may also be likely that your genes, hormones and immune system play a part in the development of adenomyosis.

What are the symptoms of adenomyosis?

Adenomyosis is a long-term condition and symptoms can range from mild to severe pelvic pain. The most common symptoms are:

• Painful periods that can be irregular
• Painful heavy periods
• Pre-menstrual pelvic pain
• Discomfort or heaviness in the pelvis

Less common adenomyosis pain symptoms include:

• Pain during sexual intercourse
• Pain related to bowel movements

It is also possible that some women with adenomyosis do not experience any symptoms. In this case, adenomyosis may be found during a routine gynaecological examination, such as during an ultrasound scan. 

How do you diagnose adenomyosis?

Diagnosing adenomyosis can be difficult because many other conditions have similar symptoms, such as uterine fibroids. This means that in some cases it can take a long time before you get to an accurate diagnosis.

The first stage in an adenomyosis diagnosis is usually by your doctor, who will carry out a pelvic examination to look for any obvious signs. They will be looking to see whether your womb (uterus) has become larger or is more painful to the touch.

The doctor may then refer you to a hospital for an adenomyosis ultrasound test. 

An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body. The scanner transmits images to a small monitor so the doctor can see if there are any signs of fibroids.

There are two types of ultrasound scan used in diagnosing a condition, these are:

• Abdominal ultrasound scan: the ultrasound probe is moved over the outside of your abdomen
• Transvaginal ultrasound scan: small probe is inserted into your vagina

To diagnose adenomyosis, a transvaginal ultrasound will be used. This can show the thickening of the muscle lining, which indicates that you may have the condition.

If an ultrasound scan is inconclusive then you may be referred for a magnetic resonance imaging (MRI) scan. An MRI scan uses a combination of magnets and radio waves to produce an image of the inside of your body.

An MRI scan can show the enlargement of the womb and thickening of certain areas, which can indicate adenomyosis.

It is important to have an accurate diagnosis of adenomyosis because this will determine the course of treatment.

What are adenomyosis treatments?

Because diagnosing adenomyosis can be difficult, most treatments address the symptoms rather than the main cause. Certain factors may influence the treatment recommendation, such as: your age and whether you want to become pregnant.

The most common treatments for adenomyosis are:

• Do nothing: This is an option if your symptoms are mild, you are trying to become pregnant, or you are nearing menopause, which is when the symptoms will stop
• Non-hormonal medicines: Some medicine, such as tranexamic acid and mefanamic acid, can help to reduce the pain and bleeding experienced during your period
• Hormonal medicines: Such as the combined oral contraceptive pill, progestogen-only pill or a hormone coil, called an IUS (intra uterine system)
• GnRh agonist injections: This is a course of hormone injections that induce a false menopause. It works by shrinking the womb lining, which causes a reversible menopause
• Hysterectomy: This is surgery to remove the womb. It can be an effective option for women who do not want to become pregnant
• Uterine artery embolisation: This procedure, which is less invasive than surgery, injects tiny particles into your blood vessels through a catheter. The aim is to cut off the blood supply to the adenomyosis. The treatment may only be effective for a limited time in reducing pain. However, it may help preserve fertility if you are likely to want to become pregnant

The condition seems to have little impact on a woman’s ability to become pregnant. However, there is some evidence that suggests it may increase the risk of miscarriage or having a premature baby. Adenomyosis symptoms will stop when you go through the menopause.

Help for adenomyosis

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem.

They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation.

An appointment with an experienced Consultant at your nearest Circle Health Group hospital can be helpful. They will assess and diagnose the cause of your symptoms and then discuss any suitable treatment options for your specific situation. To schedule your visit, book an appointment with a specialist online today.

Women's Health Matters

To find out more about the 10 most common gynaecological conditions in the UK, download our series of Women's Health Matters reports.