What is adenomyosis?

Adenomyosis occurs when endometrial tissue — the tissue that normally lines the inside of the uterus — grows into the myometrium, the muscular wall of the uterus. This can cause the uterus to become enlarged and lead to heavier, more painful periods. It's sometimes confused with endometriosis, a related but distinct condition where similar tissue grows outside the uterus instead.

Common symptoms

• Heavy or prolonged menstrual bleeding
• Severe menstrual cramping
• Pelvic pain, sometimes chronic and not limited to periods
• A feeling of pressure or bloating in the lower abdomen
• Pain during intercourse
• In some cases, no symptoms at all — sometimes discovered incidentally during an ultrasound

How adenomyosis is diagnosed

Diagnosis typically starts with a detailed symptom history, followed by a pelvic exam and imaging — usually ultrasound, and sometimes MRI for a clearer picture. Imaging has significantly improved the ability to diagnose adenomyosis without surgery, though in some cases it's confirmed only after a hysterectomy.

Treatment approaches, based on your goals

• 1

  For symptom management

  Pain medication and hormonal treatments, such as birth control pills or an IUD, can help reduce heavy bleeding and pain.

• 2

  For those planning pregnancy

  Treatment is tailored carefully, since some hormonal treatments used for symptom control aren't compatible with trying to conceive; fertility-focused management is discussed directly.

• 3

  For more severe cases

  Minimally invasive procedures, or in some cases surgery, may be considered if symptoms significantly affect quality of life and haven't responded to other treatment.

• 4

  For long-term management

  Since adenomyosis often improves after menopause, treatment is frequently focused on managing symptoms through the reproductive years.

Adenomyosis and fertility

Adenomyosis can be associated with fertility challenges for some women, though many women with adenomyosis conceive without difficulty. If fertility is a concern alongside an adenomyosis diagnosis, this is worth discussing directly, since treatment approaches differ significantly depending on whether pregnancy is a current goal.