14167 Adenomyosis

Overview

Adenomyosis is a condition where the tissue that normally lines the inside of the uterus (the endometrium) grows into the muscular wall of the uterus. This can make the uterus thick and enlarged, often causing painful, heavy periods and discomfort.

Adenomyosis is fairly common, though the exact number is hard to know because some people have no symptoms. It is often found in women in their 30s and 40s, and it may affect roughly one in five women at some stage.

It mostly affects women in their middle and later reproductive years, especially those who have had children. It is less common in teenagers and younger women, and symptoms usually ease after menopause.

Symptoms

Common symptoms

• Heavy or prolonged menstrual bleeding
• Severe cramping or sharp pain during periods
• Chronic pelvic pain that may last all month
• Pain during or after sex
• A feeling of fullness or pressure in the lower belly
• Bloating or an enlarged uterus

Symptoms in children

• Adenomyosis does not occur in children. Symptoms begin after puberty, but they are rare in teenage girls. If a teenager has very painful or heavy periods, other conditions may be the cause.

Symptoms in older adults

• In perimenopausal women, symptoms can become more noticeable, but after menopause, the condition often shrinks and symptoms typically improve or stop.
• Older women may also have vaginal bleeding or pressure, which should always be checked by a doctor to rule out other conditions.

Causes

Main causes

• The exact cause is not fully understood, but it seems to be linked to estrogen (a female hormone), which can make the misplaced tissue grow and bleed during the menstrual cycle.
• It may also happen after the uterine wall is injured, such as during childbirth or some uterine surgeries.
• Inflammation within the uterus might play a role in allowing the tissue to invade the muscle.

Risk factors

• Being in your 30s or 40s
• Having given birth to one or more children
• Having a history of uterine surgery, such as a cesarean section or fibroid removal
• Having endometriosis (many people with adenomyosis also have endometriosis)

When to see a doctor

See a doctor urgently if:

• If your bleeding is extremely heavy and you feel dizzy, weak, or short of breath, seek urgent care or call your local emergency number.
• If you have a sudden, severe pelvic or abdominal pain that is not usual for you, get medical help the same day.

Book a routine appointment if:

• If your periods are getting heavier or more painful than they used to be, make a routine appointment with your GP or gynaecologist.
• If you have pelvic pain that lasts more than a few weeks, or pain during sex, it is worth getting checked.
• If you have bleeding between periods or after menopause, see a doctor.

Diagnosis

A doctor will start by listening to your symptoms and asking about your periods, pain, and medical history. They will then do a pelvic examination to feel for an enlarged or tender uterus. Imaging tests, usually an ultrasound or sometimes an MRI, can help confirm the diagnosis by looking at the thickness and structure of the uterine wall.

Tests that may be done

• Pelvic examination
• Pelvic ultrasound (often a transvaginal ultrasound)
• Magnetic resonance imaging (MRI) for a clearer view
• Possibly a small sample of uterine tissue (biopsy) if the doctor wants to rule out other conditions

What to expect at your appointment

The diagnosis process is usually not painful, but a transvaginal ultrasound can be a bit uncomfortable. It is a short procedure, but let the person doing the scan know if you find it uncomfortable. The doctor will then explain the results with you, giving you time to ask questions and think about your options. It may take a few visits to confirm the diagnosis, so try to be patient.

Treatment

What you choose depends on how severe your symptoms are, whether you want to have children in the future, and what suits your health and lifestyle. Treatment options range from self-care and pain relief to hormonal therapies that can help control bleeding and, in the most severe cases, surgery. You should always discuss the right plan for you with your doctor.

Self-care at home

• Use a heat pad or hot water bottle on your lower abdomen to help ease cramps.
• Take over-the-counter painkillers, such as paracetamol or ibuprofen, as directed for pain relief.
• Try gentle exercise or stretching, like walking or yoga, which can improve blood flow and reduce pain.
• Keep a symptom diary to notice patterns and identify what makes pain better or worse.
• Try relaxation techniques, such as deep breathing or meditation, during painful periods.

Medical treatments

There are several medical options that a doctor may suggest. These include hormonal treatments like the combined contraceptive pill, progestogens, a hormonal coil (intrauterine system), or medicines that block the hormones that drive the condition. These treatments are not painkillers, but they can reduce bleeding and pain over time. Some treatments are not suitable if you are trying to conceive, so always discuss your plans with your doctor. There are also anti-inflammatory medicines that can be used. Do not start any new medication without your doctor’s advice.

When is surgery considered?

Surgery is usually considered only when symptoms are very severe and other treatments have not helped, or when a person has finished having children. The main operation is hysterectomy, which removes the uterus entirely. It cures adenomyosis, but it means you cannot become pregnant afterwards. Less invasive procedures, such as endometrial ablation or uterine artery embolisation, may be options for some women, but they are not suitable for everyone.

Living with this condition

Living with adenomyosis can mean planning your life around your periods. Many people find it useful to keep track of their cycle and manage their schedules for the heaviest days. Wearing dark clothing or using period pants can provide confidence if you have heavy bleeding. Don't be afraid to talk to family, friends, or your employer about how you're feeling — you deserve support.

Lifestyle tips

• Try to get enough sleep, especially before your period.
• Lower stress levels with mindfulness, gentle yoga, or a hobby you enjoy.
• If fatigue is a problem, prioritise rest and don't push yourself too hard on difficult days.
• Create a comfortable 'period kit' at home and work with pads, spare underwear, and pain relief you trust.

Diet and exercise

Eating a balanced diet with plenty of fruit, vegetables, and whole grains can help you feel better overall. Some women find reducing caffeine and processed foods helps with symptoms. Regular moderate exercise, such as walking, swimming, or cycling, can ease pain and improve mood. During flare-ups, be gentle with yourself and move only as much as feels comfortable.

Mental health and emotional wellbeing

Chronic pain and heavy bleeding can feel exhausting and stressful. It is completely normal to feel frustrated, anxious, or low at times. Because symptoms can be invisible, others may not understand how much you are struggling. Please be kind to yourself, and if you feel overwhelmed, consider talking to a counsellor or your doctor. You are not alone.

Prevention

There is currently no known way to prevent adenomyosis. Because it is likely linked to hormones and the structure of the uterus, it is not caused by anything you have done. The focus is on managing symptoms early and working with your healthcare team to preserve your quality of life.

Complications

If left untreated

• If left untreated, heavy bleeding can lead to iron-deficiency anaemia, which can cause tiredness, weakness, and breathlessness.
• Chronic pelvic pain may get worse and affect work, sleep, and relationships.
• Adenomyosis can sometimes make it harder to become pregnant, though many women still conceive without problems.

Long-term outlook

The outlook for people with adenomyosis is generally very good. Although it can be a long-term condition, symptoms often improve after menopause, and there are many effective ways to manage it in the meantime. With the right support and treatment plan, most people find that their symptoms can be controlled, allowing them to live full and active lives. Hope is absolutely warranted.

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