What is adenomyosis
Last updated: April 1, 2026
Key Facts
- Adenomyosis occurs when endometrial tissue invades the myometrium (uterine muscle)
- It primarily affects women in their 40s and 50s, though it can occur at any reproductive age
- Common symptoms include dysmenorrhea (painful periods), menorrhagia (heavy bleeding), and pelvic pain
- The exact cause is unknown but may involve uterine contractions, immune system dysfunction, and tissue inflammation
- Diagnosis typically requires MRI imaging or ultrasound, and treatment ranges from pain management to hysterectomy
Overview
Adenomyosis is a chronic gynecological condition characterized by the presence of endometrial tissue within the myometrium, the muscular wall of the uterus. This misplaced tissue continues to thicken and break down during the menstrual cycle, causing significant pain and heavy menstrual bleeding. Unlike endometriosis, where endometrial tissue grows outside the uterus, adenomyosis remains confined within the uterus itself.
Symptoms
Women with adenomyosis experience a range of symptoms that vary in severity:
- Dysmenorrhea: Severe menstrual cramps that worsen over time
- Menorrhagia: Heavy or prolonged menstrual bleeding, sometimes causing anemia
- Pelvic pain: Chronic pain during or after intercourse (dyspareunia)
- Bloating and abdominal pressure: Especially during menstruation
- Infertility: Difficulty conceiving, though the exact mechanism is unclear
Causes and Risk Factors
The exact cause of adenomyosis remains poorly understood, but several theories exist. Some researchers believe it results from invagination of the basal endometrium into the myometrium due to defective uterine contractions. Others suggest it involves immune system dysfunction, increased estrogen production, and abnormal angiogenesis (blood vessel formation). Risk factors include age over 40, multiparity (having given birth multiple times), uterine instrumentation (such as dilation and curettage), and previous uterine surgery.
Diagnosis
Diagnosis typically involves imaging studies and clinical assessment. Transvaginal ultrasound and MRI are the primary diagnostic tools, showing characteristic features such as an enlarged uterus with asymmetrical wall thickening and heterogeneous myometrial echogenicity. A definitive diagnosis can only be confirmed through histological examination of a hysterectomy specimen, though this is not routinely performed.
Treatment Options
Treatment is individualized based on symptom severity and fertility desires. Medical management includes nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and hormonal therapies such as combined oral contraceptives, progestin-releasing intrauterine devices (IUDs), or GnRH agonists. For women who do not respond to conservative treatment or have completed childbearing, hysterectomy is the definitive cure.
Related Questions
How is adenomyosis different from endometriosis?
Adenomyosis involves endometrial tissue growing into the uterine muscle wall, while endometriosis is endometrial tissue growing outside the uterus in the pelvis and abdomen. Both cause pain and infertility, but have different locations, diagnostic approaches, and treatment options.
Can adenomyosis be cured?
Hysterectomy (surgical removal of the uterus) is the only definitive cure for adenomyosis. However, symptoms can be managed with medications including NSAIDs, hormonal contraceptives, and progestin therapy for women who wish to preserve fertility.
Does adenomyosis affect fertility?
Yes, adenomyosis can reduce fertility through multiple mechanisms including altered uterine contractions, compromised endometrial receptivity, and chronic inflammation. Women with adenomyosis have lower pregnancy rates, though assisted reproductive techniques may help some patients conceive.
Sources
- Wikipedia - Adenomyosis CC-BY-SA-4.0
- Mayo Clinic - Adenomyosis Fair Use