What is the difference between adenomyosis and endometriosis?

Both involve endometrial-like tissue growing where it should not. In adenomyosis it grows into the muscle wall of the uterus itself, causing an enlarged, tender uterus and heavy painful periods. In endometriosis it grows outside the uterus, on the ovaries, bowel, or pelvic lining. The two conditions often occur together and share some treatments.

Can I still get pregnant with adenomyosis?

Many women with adenomyosis conceive and carry pregnancies normally, although the condition is associated with somewhat reduced fertility and higher rates of miscarriage and preterm birth. Women having difficulty conceiving should mention the diagnosis to a fertility specialist, as treatment before IVF may improve outcomes.

Is hysterectomy the only cure?

Hysterectomy is the only treatment that removes the condition entirely, and it is highly effective for women who have completed their families. However, hormonal treatments, particularly the levonorgestrel IUD, control symptoms very well for many women, and uterus-sparing procedures are available. Symptoms also resolve naturally after menopause.

Does adenomyosis cause cancer?

No. Adenomyosis is a benign condition and does not increase the risk of uterine cancer. Because its symptoms overlap with other conditions, however, any bleeding after menopause or unusual bleeding patterns should be assessed to rule out other causes.

ReproductiveICD-10: N80.0Common; frequently found in women in their 40s with heavy, painful periods and increasingly recognized in younger women

Adenomyosis

Also known as: Uterine adenomyosis, Internal endometriosis

Adenomyosis is a condition in which the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus. With each menstrual cycle this misplaced tissue thickens, breaks down, and bleeds inside the muscle, causing the uterus to enlarge and become tender. The result is often heavy, prolonged, and painful periods, chronic pelvic pain, and pain during sex. Adenomyosis is most often diagnosed in women in their 40s who have had children, though it is increasingly recognized in younger women with the help of better imaging. It is benign and not linked to cancer, and symptoms stop after menopause. Treatment ranges from hormonal medications to procedures that reduce bleeding and, for women who have completed their families, hysterectomy, which is the only definitive cure.

At a Glance

Common symptoms: Heavy or prolonged menstrual bleeding, sometimes with large clots, Severe cramping or sharp, knife-like pelvic pain during periods, Chronic pelvic pain or pressure between periods
Main treatments: Nonsteroidal anti-inflammatory drugs started just before and during periods to reduce pain and bleeding, Hormonal treatments such as the levonorgestrel intrauterine device, combined or progestin-only pills, or injections, which thin the lining and reduce bleeding and pain, GnRH analogs or antagonists for short-term use to induce a temporary menopause-like state
Category: Reproductive · Common; frequently found in women in their 40s with heavy, painful periods and increasingly recognized in younger women
See a doctor if: Periods that soak through a pad or tampon every hour for several hours, or last more than seven days

Symptoms

Heavy or prolonged menstrual bleeding, sometimes with large clots

Severe cramping or sharp, knife-like pelvic pain during periods

Chronic pelvic pain or pressure between periods

Pain during sexual intercourse

An enlarged, tender uterus that may cause a feeling of bloating or fullness in the lower abdomen

Anemia-related fatigue from heavy blood loss

Some women have no symptoms and are diagnosed incidentally

Causes

The exact cause is unknown
Invasive growth of endometrial cells into the uterine muscle, possibly through tiny tears created by surgery or pregnancy
Developmental origin, where endometrial tissue was deposited in the muscle before birth
Stem cells in the uterine muscle differentiating into endometrial tissue
Estrogen-driven growth, since the condition depends on hormones and resolves after menopause
Inflammation of the uterine lining after childbirth

Risk Factors

Age 35 to 50
Having had one or more pregnancies
Previous uterine surgery such as cesarean section, fibroid removal, or dilation and curettage
Coexisting endometriosis or fibroids
Short menstrual cycles and early first period, which increase lifetime estrogen exposure

Diagnosis

A history of heavy, painful periods and a pelvic examination revealing an enlarged, tender uterus
Transvaginal ultrasound, which can show a thickened uterine wall and characteristic changes
MRI of the pelvis, which is the most accurate imaging test and helps distinguish adenomyosis from fibroids
Blood tests for anemia
Definitive diagnosis only by examining the uterus after hysterectomy, although imaging is now reliable enough to guide treatment

Treatment

Nonsteroidal anti-inflammatory drugs started just before and during periods to reduce pain and bleeding
Hormonal treatments such as the levonorgestrel intrauterine device, combined or progestin-only pills, or injections, which thin the lining and reduce bleeding and pain
GnRH analogs or antagonists for short-term use to induce a temporary menopause-like state
Tranexamic acid during periods to reduce heavy bleeding
Uterine artery embolization or focused ultrasound as uterus-sparing procedures in selected cases
Hysterectomy for women with severe symptoms who have completed childbearing
Supportive: heat, regular exercise, and iron-rich foods or supplements to counter anemia; some women find a lower-inflammatory diet helpful though evidence is limited

Prevention

There is no known way to prevent adenomyosis
Seek evaluation for heavy or painful periods rather than accepting them as normal
Treat iron deficiency anemia from heavy bleeding
Discuss hormonal options early if symptoms are affecting daily life
Maintain a healthy weight, which can reduce estrogen-driven symptoms

When to See a Doctor

Periods that soak through a pad or tampon every hour for several hours, or last more than seven days
Period pain that does not respond to over-the-counter pain relief or keeps you from normal activities
Pain during sex or persistent pelvic pain
Symptoms of anemia such as fatigue, breathlessness, or dizziness
Bleeding after menopause, which needs prompt investigation for other causes

Frequently Asked Questions

Related Conditions

Endometriosis

Reproductive

Uterine Fibroids

Reproductive

Dysmenorrhea

Reproductive

Iron Deficiency Anemia

Metabolic

Infertility

Reproductive

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