Adenomyosis: Causes, Symptoms, Diagnosis, and Treatment

What Is Adenomyosis?

Adenomyosis is a gynaecological condition in which tissue similar to the endometrium, the lining of the uterus, is found within the muscular wall of the uterus (myometrium). This can cause the uterus to become enlarged and may lead to heavy menstrual bleeding, painful periods, and pelvic discomfort.

Adenomyosis affects people differently. Some experience significant pain and bleeding, while others have few or no noticeable symptoms. The condition is generally more common during the reproductive years, and symptoms often improve after menopause.

Adenomyosis may also be relevant when evaluating fertility concerns. However, having adenomyosis does not automatically mean someone will experience infertility or require fertility treatment.

What Are the Types of Adenomyosis?

Adenomyosis is commonly described according to how the affected tissue is distributed within the uterine muscle.

• Focal adenomyosis: The affected tissue is concentrated in a specific area of the uterine muscle. A localised mass of adenomyosis may be called an adenomyoma.
• Diffuse adenomyosis: The condition affects a broader area of the uterine muscle rather than being limited to one location.

The type, extent, and severity of adenomyosis can influence symptoms and help doctors determine an appropriate treatment plan.

What Causes Adenomyosis?

The exact cause of adenomyosis is not fully understood. Researchers believe several biological and hormonal factors may contribute to its development.

1. Hormonal Factors

Adenomyosis is associated with hormonal activity, particularly oestrogen. Hormonal changes during the menstrual cycle may influence the growth and activity of the affected tissue.

2. Changes in Uterine Tissue

One proposed explanation is that changes at the boundary between the uterine lining and the muscular wall may allow endometrial tissue to extend into the muscle. The precise process is still being investigated.

3. Uterine Inflammation and Tissue Repair

Inflammation and tissue repair processes may play a role in the development of adenomyosis, although the relationship is not completely established.

4. Previous Uterine Procedures

Adenomyosis has been associated with factors such as previous childbirth and uterine procedures, including caesarean delivery or surgery for fibroids. However, these factors do not necessarily cause the condition, and adenomyosis can occur without a history of uterine surgery.

What Are the Symptoms of Adenomyosis?

Symptoms vary considerably. Some people have no symptoms, while others experience discomfort that affects daily activities.

Common symptoms include:

• Painful periods: Menstrual cramps may be severe or become more painful over time.
• Heavy menstrual bleeding: Periods may be unusually heavy or prolonged, sometimes with blood clots.
• Pelvic pain: Persistent or recurring discomfort may occur in the lower abdomen or pelvis.
• Abdominal pressure or bloating: An enlarged uterus may contribute to a feeling of fullness or pressure.
• Pain during sexual intercourse: Some people experience discomfort or pain during sex.
• Fatigue: Heavy or prolonged bleeding may lead to iron-deficiency anaemia, which can cause tiredness, weakness, or breathlessness.

These symptoms can overlap with other conditions, including uterine fibroids and endometriosis. A medical evaluation is important to identify the likely cause.

How Is Adenomyosis Diagnosed?

Adenomyosis is usually evaluated through a combination of medical history, physical examination, and imaging tests. No single symptom is sufficient to confirm the diagnosis.

1. Medical History and Pelvic Examination

A doctor may ask about menstrual patterns, pain, bleeding, previous pregnancies, and uterine procedures. A pelvic examination may reveal an enlarged or tender uterus, although these findings are not specific to adenomyosis.

2. Transvaginal Ultrasound

Transvaginal ultrasound is commonly used as the initial imaging test. It can help identify features associated with adenomyosis, such as:

• Changes in the thickness or appearance of the uterine muscle.
• Small cyst-like areas within the myometrium.
• An irregular appearance of the uterine muscle or the boundary between the uterine lining and muscle.

Ultrasound findings must be interpreted by a qualified clinician because adenomyosis can sometimes resemble other uterine conditions.

3. Magnetic Resonance Imaging (MRI)

An MRI may be recommended when ultrasound findings are unclear or when more detailed assessment is needed. It can help evaluate the distribution of adenomyosis and distinguish it from other conditions, including fibroids.

4. Evaluation of Related Conditions

Depending on the symptoms, doctors may investigate other possible causes of pelvic pain or heavy bleeding. Blood tests may also be recommended to check for anaemia. In people experiencing fertility difficulties, the assessment may include additional investigations based on their reproductive history and treatment goals.

How Is Adenomyosis Treated?

Treatment depends on symptom severity, age, general health, and whether the person wishes to become pregnant. Not everyone with adenomyosis needs treatment.

1. Treatment for Mild Symptoms

For mild or manageable symptoms, a doctor may recommend:

• Anti-inflammatory medicines: Non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve menstrual pain when medically appropriate.
• Hormonal medicines: Certain contraceptive pills, patches, or other hormonal treatments may help reduce pain and bleeding.
• Hormonal intrauterine devices (IUDs): Some hormonal IUDs can help manage heavy menstrual bleeding and menstrual pain.

The most suitable option depends on individual circumstances. Some hormonal treatments prevent pregnancy while being used, so they may not be appropriate for someone actively trying to conceive.

2. Treatment for Moderate to Severe Symptoms

When symptoms are persistent or significantly affect quality of life, a specialist may discuss additional options.

• Other hormonal treatments: Certain medicines may temporarily suppress hormonal activity and reduce symptoms. Their suitability depends on potential side effects and individual health factors.
• Adenomyomectomy: In selected cases of focal adenomyosis, surgery may remove the affected tissue while preserving the uterus. The procedure can be complex, and its suitability depends on the extent and location of the disease.
• Uterine artery embolisation (UAE): This procedure reduces blood flow to the uterus and may improve symptoms in selected patients. Its effects on future fertility and pregnancy are important considerations, so it requires careful specialist counselling.

Treatment options should be discussed with a gynaecologist, particularly when future pregnancy is a priority.

3. Adenomyosis Treatment for People Planning Pregnancy

Adenomyosis may be associated with difficulties conceiving or certain pregnancy complications, but its effect varies from person to person. A diagnosis alone does not determine whether natural conception will be possible.

A fertility specialist may recommend:

• Assessing other factors that could affect conception, including ovulation, fallopian tube health, and sperm quality.
• Reviewing the severity and extent of adenomyosis.
• Considering treatment to manage symptoms when appropriate.
• Discussing assisted reproductive techniques, including in vitro fertilisation (IVF), when indicated by the overall fertility assessment.

IVF may be an option for some individuals, but it does not guarantee pregnancy or a live birth. The best approach depends on age, reproductive history, other fertility factors, and the characteristics of the condition.

People considering surgery or uterine artery embolisation should discuss potential effects on future pregnancy before proceeding.

4. Hysterectomy for Severe Adenomyosis

For people who do not wish to become pregnant in the future and have severe symptoms that do not respond to other treatments, hysterectomy (surgical removal of the uterus) may be considered.

It is a definitive treatment for adenomyosis in the uterus, but it permanently removes the ability to carry a pregnancy. The decision requires a detailed discussion of benefits, risks, and alternatives with a gynaecologist.

When Should You See a Doctor?

Consider consulting a gynaecologist if you experience:

• Severe or worsening menstrual cramps.
• Heavy or prolonged periods.
• Persistent pelvic pain or pressure.
• Fatigue, weakness, or breathlessness that may be related to heavy bleeding.
• Difficulty conceiving or concerns about reproductive health.

Seek urgent medical attention if you experience very heavy bleeding accompanied by faintness, severe weakness, shortness of breath, or sudden intense pelvic pain.

Early assessment can help identify the cause of symptoms and guide appropriate care.

Adenomyosis and Fertility Care at Jyoti IVF

Adenomyosis can cause significant discomfort and may be relevant when evaluating fertility concerns. However, treatment should be based on an individual’s symptoms, reproductive goals, and overall health rather than the diagnosis alone.

At Jyoti IVF, people seeking fertility guidance can discuss their reproductive concerns with a qualified specialist and explore which investigations or treatment options may be appropriate for their circumstances.

A personalised evaluation can help clarify whether adenomyosis is likely to affect conception and whether further fertility assessment or treatment may be beneficial.

Frequently Asked Questions (FAQs)

1. Can adenomyosis cause infertility?

Adenomyosis may be associated with reduced fertility in some people, but it does not automatically cause infertility. Its impact depends on the severity of the condition and other reproductive factors.

2. Can adenomyosis go away on its own?

Adenomyosis symptoms often improve after menopause as hormone levels decline. Before menopause, symptoms may fluctuate, but the condition does not necessarily disappear without treatment.

3. Is adenomyosis the same as endometriosis?

No. Adenomyosis involves endometrium-like tissue within the muscular wall of the uterus. Endometriosis involves similar tissue growing outside the uterus. Both can cause pelvic pain, and they may occur together.

4. Can adenomyosis be detected by ultrasound?

Yes. Transvaginal ultrasound is commonly used to look for features associated with adenomyosis. An MRI may be recommended if further clarification is needed.

5. Is surgery always necessary for adenomyosis?

No. Many people manage their symptoms with medication or do not require treatment. Surgery is considered in selected cases depending on symptom severity, response to other treatments, and future pregnancy plans.

6. Can someone with adenomyosis become pregnant naturally?

Yes, natural pregnancy is possible. The likelihood depends on individual circumstances, including age, ovulation, fallopian tube health, sperm quality, and the extent of adenomyosis.

7. Does IVF help people with adenomyosis?

IVF may be recommended when fertility difficulties warrant assisted reproduction. The treatment plan may also consider how adenomyosis could affect implantation and pregnancy. Outcomes vary, and success cannot be guaranteed.

Medical disclaimer: This article is for general educational purposes and does not replace professional medical advice, diagnosis, or treatment. Consult a qualified gynaecologist or fertility specialist for guidance based on your individual health and reproductive goals.