Adenomyosis is a common condition that is often difficult to diagnose. In this article we cover the basics of adenomyosis, it’s symptoms, diagnosis and how to access care.

What is adenomyosis?

Adenomyosis is a condition where the lining of the womb is found deep in the muscle of the uterus. We do not know exactly why this happens but it is likely that women with adenomyosis have a predisposition due to their genes, immune system and hormones.

Image showing the reproductive system of a female with adenomyosis

Adenomyosis affects as many as one in ten women of reproductive age. It is more common in women aged 40-50 years.

What are the symptoms of adenomyosis?

About one third of women experience few or no symptoms; other women can have many effects. It can also affect other aspects of a woman’s life including her general physical health and emotional wellbeing. 

The most common symptoms are:

  • Heavy, painful or irregular periods
  • Pre-menstrual pelvic pain and feelings of heaviness/discomfort in the pelvis

Less common symptoms are:

  • Pain during sexual intercourse
  • Pain related to bowel movements

Adenomyosis is difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women who have heavy and painful periods accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be.

As a guide if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours you should consider visiting your GP.

What causes adenomyosis?

The cause isn’t known, however there have been many theories, including:

  • Invasive tissue growth – Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. 
  • Developmental origins – Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.

There are other theories but none of these fully explain adenomyosis. 

How to test for adenomyosis?

Adenomyosis can take a long time, even years, to diagnose because the symptoms and severity can vary between women.

Your doctor may organise and perform a transvaginal ultrasound scan and/or an MRI to investigate your symptoms.

How is it managed? 

The right treatment depends on symptoms but also other factors including age, desire for children and preserving fertility, views on surgery and what treatments have been tried already.

Options include:

  • Watching how things go (called expectant management) – if symptoms are mild or treatments aren’t a good option
  • Non-hormonal treatments – such as tranexamic acid or mefanamic acid to reduce pain and bleeding with your period
  • Hormonal treatments – such as the oral conceptive pill, Depo-Provera ™ injection, Nexplanon™ implant and Mirena™ coil or types that cause a temporary and false menopause state (Zoladex™). Not suitable for women wishing to conceive. 
  • Hysterectomy (removal of the womb), for women not wishing to preserve fertility
  • Uterine artery embolisation, a procedure whereby tiny particles are injected into blood vessels via a catheter in the groin aiming to block off the blood supply to the adenomyosis and cause it to shrink

What impact does it have on fertility?

Until recently, adenomyosis has been associated with having multiple children, not with infertility. This is because having children may increase the likelihood of developing adenomyosis. 

However it is now diagnosed more often in infertile patients since women are delaying their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that it has a negative impact on female fertility. 

If you have or you suspect you might have adenomyosis, don’t wait to visit your GP if trying for a baby

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