Heavy, painful periods are often brushed off as something women simply have to live with. Sometimes, though, they point to an underlying condition such as adenomyosis.
Adenomyosis is common, yet it often goes undiagnosed for years. This article explains what it is, the symptoms to look out for, how it can affect fertility and which treatment options are available.
What is adenomyosis?
Adenomyosis occurs when tissue similar to the lining of the uterus (the endometrium) grows into the muscular wall of the uterus.
This misplaced tissue still responds to your monthly hormones. It thickens and bleeds with each cycle, but because it is trapped inside the muscle, it causes inflammation, pain and swelling. Over time, the uterus can become enlarged and tender.
Adenomyosis can affect the whole uterine wall or appear in one area, known as focal adenomyosis.
Adenomyosis vs endometriosis
The two conditions are closely related but not the same. With endometriosis, similar tissue grows outside the uterus. With adenomyosis, it grows within the uterine muscle. Many women have both, and the symptoms often overlap.
Who does adenomyosis affect?
Adenomyosis was once thought to mainly affect women in their 40s and 50s. Modern imaging has shown that it can also occur in younger women, including those trying to conceive.
It appears to be more common in women over 40 and in those with a history of recurrent miscarriage. It is also frequently picked up during fertility investigations.
Common symptoms of adenomyosis
Some women have mild symptoms or none at all. Others experience symptoms that affect their daily lives, including:
- Heavy or prolonged periods
- Severe period pain and cramping
- Ongoing pelvic pain or a feeling of pressure
- Bloating and a tender lower abdomen
- Pain during sex
- Difficulty falling pregnant
Because these symptoms are shared with other conditions, such as fibroids, they cannot confirm adenomyosis on their own.
How is adenomyosis diagnosed?
In the past, adenomyosis could only be confirmed after a hysterectomy. Today, imaging allows doctors to diagnose it without surgery.
Transvaginal ultrasound is usually the first test. It can show an enlarged, bulky uterus or changes in the muscle wall.
MRI provides more detailed images and is useful when fibroids or endometriosis are also suspected.
Your specialist will combine these results with your medical history and a pelvic examination to make an accurate diagnosis.
How does adenomyosis affect fertility?
Adenomyosis does not automatically prevent pregnancy, but it can make conception more difficult for some women.
The inflammation it causes can change the environment inside the uterus. This may make it harder for an embryo to implant and grow. It has also been linked to a higher risk of miscarriage.
Research on fertility treatment outcomes is mixed. Some studies link adenomyosis to lower pregnancy rates with IVF, while others find a smaller effect once factors such as age are taken into account.
The encouraging news is that many women with adenomyosis do conceive, either naturally or with the right fertility support.
Treatment options for adenomyosis
There is no single standard treatment. Your plan will depend on your symptoms, your age and whether you hope to have children.
Medication
Anti-inflammatory painkillers can ease cramping. Hormonal treatments, such as the contraceptive pill, progestogen-based medication or a hormone-releasing intrauterine device, can reduce bleeding and pain. These manage symptoms but do not cure the condition.
Minimally invasive procedures
Uterine artery embolisation reduces the blood supply to the affected tissue. It can relieve symptoms, but it is not usually recommended for women planning a pregnancy.
Surgery
For focal adenomyosis, a surgeon may remove the affected area while preserving the uterus. A hysterectomy is the only permanent cure, but it is only an option for women who have completed their families.
Fertility treatment
For women trying to conceive, a specialist may use hormonal medication to calm the condition before treatment. In IVF, a frozen embryo transfer is often recommended. This allows the uterus to be prepared under controlled conditions, which some studies suggest may improve live birth rates.
How Fertility Choice can help
At Fertility Choice, we understand how frustrating it can be to live with painful symptoms while trying to start a family. Our specialists can investigate the cause of your symptoms and build a personalised plan to manage adenomyosis and support your fertility goals.
Conclusion
Adenomyosis is a common but often overlooked cause of heavy, painful periods and fertility challenges. With an accurate diagnosis and tailored treatment, many women manage their symptoms and go on to have successful pregnancies.
If you are concerned about adenomyosis, contact Fertility Choice to book a consultation.
FAQs
Is adenomyosis a serious problem?
Adenomyosis is not life-threatening or cancerous. However, it can cause significant pain and heavy bleeding, which may lead to anaemia, and it can affect fertility. It is worth seeing a specialist if symptoms affect your quality of life.
What should you do if you have adenomyosis?
Speak to a gynaecologist or fertility specialist about your symptoms and plans for a family. They can recommend treatment to manage pain and bleeding and, if you want to conceive, a fertility plan suited to you.
What is the root cause of adenomyosis?
The exact cause is not fully understood. It may develop when the uterine lining grows into the muscle wall, possibly after childbirth or uterine surgery such as a caesarean section. Hormones, particularly oestrogen, are believed to play a role.
What does adenomyosis belly look like?
Adenomyosis belly describes a swollen or bloated lower abdomen caused by an enlarged uterus. Some women notice their lower belly looks rounded or distended, sometimes resembling early pregnancy, especially around their period.
