Adenomyosis (pronounced “add-en-o-my-OH-sis”) is a condition that occurs when tissue similar to the lining of the uterus (endometrium) grows into the muscle wall of the uterus (myometrium). It can cause the uterus to thicken and enlarge – sometimes up to double or triple its usual size – and produce other symptoms, like painful periods and heavy menstrual bleeding.

Often confused with endometriosis, which occurs when tissue similar to the lining of the uterus implants OUTSIDE of the uterus, adenomyosis is a distinct condition with its own set of symptoms and treatments.

Experts don’t know what causes adenomyosis (or how common it is), but they have identified a few risk factors for the condition. So, people assigned female at birth may have a higher chance of developing adenomyosis if:

• They are between the ages of 40 and 50
• They have given birth at least once
• The have had a previous uterine surgery

Signs and Symptoms of Adenomyosis

Because the tissue that causes adenomyosis is similar to the tissue that lines the inside of the uterus, adenomyosis tissue also responds to hormones, which means it thickens, sheds, and bleeds in step with a person’s monthly cycle. This is why most of the symptoms related to adenomyosis are similar to period symptoms, even if adenomyosis usually causes a more extreme version of those symptoms.

Here are some of the most common symptoms people with adenomyosis experience:

• Painful period cramps
• Heavy menstrual bleeding
• Abnormal cycles – short, long, and/or skipped periods
• Pelvic pain
• Painful intercourse
• Infertility
• Enlarged uterus
• Bloating or fullness in the belly

Diagnosing and Treating Adenomyosis

Healthcare providers often make a diagnosis of adenomyosis based on your symptoms and her clinical experience, but there are a few tests that can be helpful in confirming the diagnosis.

• Pelvic exam: During a pelvic exam, your provider will palpate (feel) your lower abdomen and may notice your uterus has gotten larger, softer/spongier, or painful to the touch.
• Transvaginal ultrasound: A transvaginal ultrasound can show thickening of your uterine wall. While an ultrasound might not provide a high-resolution image of the muscle wall, it’s a quick and easy procedure that can be performed in-office and help rule out other conditions, such as endometriosis or uterine fibroids.
• MRI (magnetic resonance imaging): An MRI is the best way to confirm a diagnosis of adenomyosis. It provides a high-resolution image that allows a provider to precisely visualize the endometrial tissue invading the muscle wall of the uterus.

Managing and Treating Adenomyosis

Since estrogen promotes the growth of endometrial tissue, adenomyosis symptoms often go away after menopause. This is positive news. Because adenomyosis usually doesn’t become symptomatic until a person reaches her 40s or 50s, symptoms can often be managed with a commonsense, conservative approach until your body enters menopause.

The treatment options listed below run the gamut from conservative to more invasive, but each of these strategies can be considered a viable option, depending on the severity of symptoms and desire to get relief before menopause arrives.

• Pain medication: NSAIDs (Advil, Motrin) can ease period pain and cramps. Speak to your provider about dosing and timing. Sometimes, it helps to premedicate with NSAIDs a few days before period symptoms begin to achieve the most effective pain management.
• Hormone treatment: Hormone-based birth control pills, IUDs, and other hormone-based contraceptives can often improve heavy bleeding, cramps, and other period-related symptoms. It won’t work right away, but when it does work, hormone treatment is a safe and effective way to manage adenomyosis symptoms.
• Non-hormonal medication: If hormone therapy isn’t in your wheelhouse, non-hormonal medications, like tranexamic acid, can reduce vaginal bleeding and ameliorate other adenomyosis symptoms.
• Adenomyomectomy: This surgery, which requires general anesthesia, removes the adenomyosis from your uterine muscle. This procedure is similar to a myomectomy, which is performed to remove uterine fibroids.
• Hysterectomy: The only way to fully treat adenomyosis is with a hysterectomy (surgery to remove the uterus). Adenomyosis often causes diffuse, finger-like projections when it invades the uterine wall, so it’s nearly impossible to remove all adenomyosis with other surgical procedures (adenomyomectomy) or completely eradicate symptoms with non-invasive treatment options, like pain meds or hormone therapy.

Since there isn’t really a way to reduce your chances of developing adenomyosis, it’s important to understand the symptoms and treatment options, just in case you get diagnosed with this condition. Thankfully, there are several safe and effective management strategies at your disposal. Also, since adenomyosis doesn’t generally cause major problems until a person reaches her 40s or 50s, menopause usually offers natural relief.

There is one more piece of positive news about adenomyosis: While adenomyosis can cause uncomfortable symptoms, it doesn’t cause cancer or any clinically-significant issues.

So, if you’re in your 40s or 50s (or younger - because adenomyosis is, unfortunately, being diagnosed more and more in younger patients), make an appointment with your provider to get checked out. To get answers. And to get relief.