Adenomyosis: could it be causing heavy and painful periods?

English version

Adenomyosis occurs when tissue similar to the uterine lining grows into the muscular wall of the uterus. This can make the wall thicker and sometimes cause the uterus to become enlarged or tender. It is more commonly diagnosed after age 30, but can affect anyone who has periods. Some women have no symptoms.

What symptoms can adenomyosis cause?

• Heavy or prolonged periods and severe menstrual cramps.
• Pelvic pain during or between periods.
• Pressure, heaviness, fullness or bloating in the lower abdomen.
• Pain during sexual intercourse.
• Repeatedly passing blood clots.
• Tiredness, weakness, dizziness or breathlessness when heavy bleeding causes anaemia.

Symptoms differ between women. Fibroids, endometriosis, uterine polyps, hormonal problems and other pelvic conditions may cause similar symptoms.

Is it the same as endometriosis or fibroids?

No. Adenomyosis affects the muscular wall within the uterus. Endometriosis involves similar tissue outside the uterus. Fibroids are non-cancerous growths made from muscle and other uterine tissue. More than one condition may be present at the same time, so symptoms and scan findings should be considered together.

How is adenomyosis assessed?

The doctor may discuss menstrual and pregnancy history, pain, bleeding and their effect on daily life, then recommend an examination. Depending on the situation, tests may include a blood count for anaemia, a pregnancy test, pelvic or transvaginal ultrasound, or MRI in selected cases.

An ultrasound may show a bulky uterus or features suggestive of adenomyosis. A single phrase in the report cannot establish the full explanation for your symptoms. Not everyone needs MRI or surgery for diagnosis.

Can it affect fertility or pregnancy?

Many women with adenomyosis conceive and have successful pregnancies. Research suggests an association with reduced fertility and some pregnancy complications in certain women, but the effect varies and evidence continues to develop. Difficulty conceiving should also prompt consideration of age, ovulation, fallopian tubes and the male partner’s fertility. Tell the doctor about present or future pregnancy plans before choosing treatment.

Does everyone need treatment?

Treatment may not be needed when symptoms are absent or mild. For troublesome pain or bleeding, options may include suitable pain medicine, tranexamic acid for selected women, hormonal contraception, a levonorgestrel-releasing intrauterine system (hormonal IUS), other hormone treatments or surgery in selected circumstances.

The choice depends on symptoms, anaemia, medical history, previous treatment and pregnancy plans. Do not start hormones or repeatedly take painkillers without individual advice; some medicines are unsuitable in certain conditions or when pregnancy is possible.

Is hysterectomy always necessary?

No. Adenomyosis on a scan does not automatically mean that the uterus must be removed. Hysterectomy may be considered when symptoms are severe, other treatments have not helped enough and future pregnancy is not desired. It is major surgery, so benefits, risks and alternatives should be discussed carefully. Endometrial ablation and other procedures are not suitable for every pattern of disease and are generally inappropriate when future pregnancy is desired.

When should you arrange a consultation?

• Periods have become much heavier, longer or more painful.
• Pain or bleeding affects work, sleep or daily activities.
• You repeatedly pass large clots or have persistent pelvic pressure or bloating.
• Sexual intercourse is painful.
• You feel unusually tired, dizzy, weak or breathless.
• Bleeding occurs between periods or after sex.
• You are trying to conceive or current treatment has not controlled symptoms.

Keeping a record of cycle dates, bleeding, pain, clots and medicines used can help during the consultation.

Adenomyosis is a benign condition, but its effects on pain, bleeding and everyday life can be significant. Treatment should reflect your symptoms and priorities, not only the wording of a scan report.