If you have very painful periods (dysmenorrhea) with or without heavy menstrual bleeding (menorrhagia), it is possible that you have a benign gynecologic condition called adenomyosis.
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What Is Adenomyosis?
Adenomyosis occurs in the uterus and is a common cause of painful periods and heavy menstrual bleeding.
Your uterus is made of smooth muscle that is lined with a special layer called theendometrium. The endometrium is what builds up and sheds in response to changes in your hormone levels during your menstrual cycle every month. Normally the endometrium is separated from the muscle layer of the uterus (the myometrium). In women who have adenomyosis, the endometrial lining has spread into the muscular wall of the uterus.
These areas of endometrium embedded in the wall of the uterus undergo the same hormonal changes as the normal endometrium. These changes result inirritation and inflammationin the muscle of the uterus resulting in pain and altered blood flow that causes heavier menstrual bleeding.
Causes
The cause of adenomyosis is still up for debate in the medical community.
The peak age of adenomyosis diagnosis is between the ages of 40–50 years old, but because it has typically been diagnosed in cases of hysterectomy, this figure may be skewed. Adenomyosis can also occur in younger women and adolescents, but its prevalence is unclear. The diagnosis should certainly be considered in younger women and adolescents having extremely painful periods that do not respond to usual treatments.
Symptoms
While many women who have adenomyosis areasymptomatic, women who do experience symptoms may have severe dysmenorrhea and heavy menstrual bleeding. It is not uncommon that if you are diagnosed with adenomyosis, you may also be diagnosed with uterine fibroids or endometriosis.The combination of these benign gynecologic conditions can result in increased severity of the symptoms of painful periods and heavy menstrual bleeding.
Diagnosis
If your healthcare provider suspects that you have adenomyosis, they will likely order a transvaginal ultrasound or anMRIof your pelvis.These imaging studies do a fairly good job of confirming the diagnosis. In some situations, your healthcare provider may suggest a biopsy of the wall of your uterus to confirm the diagnosis of adenomyosis, although this is not typically indicated.
Treatment
Once you are diagnosed with adenomyosis, your healthcare provider will likely suggest different treatment options. The option that is right for you will depend on your age, the severity of your symptoms, your plans for future pregnancies, and whether or not you also have uterine fibroids or endometriosis. Your healthcare provider may suggest that you try medical management before considering a surgical option. The goal of medical treatment is to control the symptoms of painful periods and heavy menstrual bleeding.
Medications that your healthcare provider may suggest include:
Mirena(a progestin-releasing intrauterine device) may also used to manage adenomyosis.
These medical options may or may not help your symptoms. Of these medical options, the evidence suggests that the Mirena IUD may be the most effective in controlling the symptoms of adenomyosis.
If medical management fails to control your symptoms and you are done having children, your healthcare provider may suggest a surgical option. The most definitive surgical treatment is removing your uterus (hysterectomy).Depending on the extent of the adenomyosis, your healthcare provider may discuss other options that would allow you to keep your uterus. These options include:
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F.The impact of adenomyosis on women’s fertility.Obstet Gynecol Surv. 2016;71(9):557-568. doi:10.1097/OGX.0000000000000346Wang S, Duan H.The role of the junctional zone in the management of adenomyosis with infertility.Front Endocrinol (Lausanne). 2023;14:1246819. doi:10.3389/fendo.2023.1246819Upson K, Missmer SA.Epidemiology of adenomyosis.Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718920Cunningham RK, Horrow MM, Smith RJ, Springer J.Adenomyosis: a sonographic diagnosis.Radiographics. 2018;38(5):1576-1589. doi:10.1148/rg.2018180080Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y.Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.Insights Imaging. 2019;10(1):48. doi:10.1186/13244-019-0732-8Ferraz, Z., Nogueira-Martins, N., & Nogueira-Martins, F. (2017).Adenomyosis: Back to the future?.Facts, views & vision in ObGyn.2017: 9(1):15–20.Agostinho L, Cruz R, Osório F, Alves J, Setúbal A, Guerra A.MRI for adenomyosis: a pictorial review.Insights Imaging. 2017;8(6):549-556. doi:10.1007/s13244-017-0576-zDi Spiezio Sardo A, Calagna G, Santangelo F, et al.The role of hysteroscopy in the diagnosis and treatment of adenomyosis.Biomed Res Int. 2017;2017:2518396. doi:10.1155/2017/2518396Li JJ, Chung JPW, Wang S, Li TC, Duan H.The investigation and management of adenomyosis in women who wish to improve or preserve fertility.Biomed Res Int. 2018;2018:6832685. doi:10.1155/2018/6832685Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F.Role of medical therapy in the management of uterine adenomyosis.Fertil Steril. 2018;109(3):398-405. doi:10.1016/j.fertnstert.2018.01.013Kumar V, Chodankar R, Gupta JK.Endometrial ablation for heavy menstrual bleeding.Womens Health (Lond Engl). 2016;12(1):45-52. doi:10.2217/whe.15.86Ma J, Brown B, Liang E.Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.Aust N Z J Obstet Gynaecol. 2021;61(2):290-296. doi:10.1111/ajo.13304Ota Y, Ota K, Takahashi T, Suzuki S, Sano R, Shiota M.New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: a case report.Heliyon. 2020;6(8):e04628. doi:10.1016/j.heliyon.2020.e04628
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F.The impact of adenomyosis on women’s fertility.Obstet Gynecol Surv. 2016;71(9):557-568. doi:10.1097/OGX.0000000000000346Wang S, Duan H.The role of the junctional zone in the management of adenomyosis with infertility.Front Endocrinol (Lausanne). 2023;14:1246819. doi:10.3389/fendo.2023.1246819Upson K, Missmer SA.Epidemiology of adenomyosis.Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718920Cunningham RK, Horrow MM, Smith RJ, Springer J.Adenomyosis: a sonographic diagnosis.Radiographics. 2018;38(5):1576-1589. doi:10.1148/rg.2018180080Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y.Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.Insights Imaging. 2019;10(1):48. doi:10.1186/13244-019-0732-8Ferraz, Z., Nogueira-Martins, N., & Nogueira-Martins, F. (2017).Adenomyosis: Back to the future?.Facts, views & vision in ObGyn.2017: 9(1):15–20.Agostinho L, Cruz R, Osório F, Alves J, Setúbal A, Guerra A.MRI for adenomyosis: a pictorial review.Insights Imaging. 2017;8(6):549-556. doi:10.1007/s13244-017-0576-zDi Spiezio Sardo A, Calagna G, Santangelo F, et al.The role of hysteroscopy in the diagnosis and treatment of adenomyosis.Biomed Res Int. 2017;2017:2518396. doi:10.1155/2017/2518396Li JJ, Chung JPW, Wang S, Li TC, Duan H.The investigation and management of adenomyosis in women who wish to improve or preserve fertility.Biomed Res Int. 2018;2018:6832685. doi:10.1155/2018/6832685Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F.Role of medical therapy in the management of uterine adenomyosis.Fertil Steril. 2018;109(3):398-405. doi:10.1016/j.fertnstert.2018.01.013Kumar V, Chodankar R, Gupta JK.Endometrial ablation for heavy menstrual bleeding.Womens Health (Lond Engl). 2016;12(1):45-52. doi:10.2217/whe.15.86Ma J, Brown B, Liang E.Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.Aust N Z J Obstet Gynaecol. 2021;61(2):290-296. doi:10.1111/ajo.13304Ota Y, Ota K, Takahashi T, Suzuki S, Sano R, Shiota M.New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: a case report.Heliyon. 2020;6(8):e04628. doi:10.1016/j.heliyon.2020.e04628
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F.The impact of adenomyosis on women’s fertility.Obstet Gynecol Surv. 2016;71(9):557-568. doi:10.1097/OGX.0000000000000346Wang S, Duan H.The role of the junctional zone in the management of adenomyosis with infertility.Front Endocrinol (Lausanne). 2023;14:1246819. doi:10.3389/fendo.2023.1246819Upson K, Missmer SA.Epidemiology of adenomyosis.Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718920Cunningham RK, Horrow MM, Smith RJ, Springer J.Adenomyosis: a sonographic diagnosis.Radiographics. 2018;38(5):1576-1589. doi:10.1148/rg.2018180080Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y.Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.Insights Imaging. 2019;10(1):48. doi:10.1186/13244-019-0732-8Ferraz, Z., Nogueira-Martins, N., & Nogueira-Martins, F. (2017).Adenomyosis: Back to the future?.Facts, views & vision in ObGyn.2017: 9(1):15–20.Agostinho L, Cruz R, Osório F, Alves J, Setúbal A, Guerra A.MRI for adenomyosis: a pictorial review.Insights Imaging. 2017;8(6):549-556. doi:10.1007/s13244-017-0576-zDi Spiezio Sardo A, Calagna G, Santangelo F, et al.The role of hysteroscopy in the diagnosis and treatment of adenomyosis.Biomed Res Int. 2017;2017:2518396. doi:10.1155/2017/2518396Li JJ, Chung JPW, Wang S, Li TC, Duan H.The investigation and management of adenomyosis in women who wish to improve or preserve fertility.Biomed Res Int. 2018;2018:6832685. doi:10.1155/2018/6832685Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F.Role of medical therapy in the management of uterine adenomyosis.Fertil Steril. 2018;109(3):398-405. doi:10.1016/j.fertnstert.2018.01.013Kumar V, Chodankar R, Gupta JK.Endometrial ablation for heavy menstrual bleeding.Womens Health (Lond Engl). 2016;12(1):45-52. doi:10.2217/whe.15.86Ma J, Brown B, Liang E.Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.Aust N Z J Obstet Gynaecol. 2021;61(2):290-296. doi:10.1111/ajo.13304Ota Y, Ota K, Takahashi T, Suzuki S, Sano R, Shiota M.New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: a case report.Heliyon. 2020;6(8):e04628. doi:10.1016/j.heliyon.2020.e04628
Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F.The impact of adenomyosis on women’s fertility.Obstet Gynecol Surv. 2016;71(9):557-568. doi:10.1097/OGX.0000000000000346
Wang S, Duan H.The role of the junctional zone in the management of adenomyosis with infertility.Front Endocrinol (Lausanne). 2023;14:1246819. doi:10.3389/fendo.2023.1246819
Upson K, Missmer SA.Epidemiology of adenomyosis.Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718920
Cunningham RK, Horrow MM, Smith RJ, Springer J.Adenomyosis: a sonographic diagnosis.Radiographics. 2018;38(5):1576-1589. doi:10.1148/rg.2018180080
Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y.Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.Insights Imaging. 2019;10(1):48. doi:10.1186/13244-019-0732-8
Ferraz, Z., Nogueira-Martins, N., & Nogueira-Martins, F. (2017).Adenomyosis: Back to the future?.Facts, views & vision in ObGyn.2017: 9(1):15–20.
Agostinho L, Cruz R, Osório F, Alves J, Setúbal A, Guerra A.MRI for adenomyosis: a pictorial review.Insights Imaging. 2017;8(6):549-556. doi:10.1007/s13244-017-0576-z
Di Spiezio Sardo A, Calagna G, Santangelo F, et al.The role of hysteroscopy in the diagnosis and treatment of adenomyosis.Biomed Res Int. 2017;2017:2518396. doi:10.1155/2017/2518396
Li JJ, Chung JPW, Wang S, Li TC, Duan H.The investigation and management of adenomyosis in women who wish to improve or preserve fertility.Biomed Res Int. 2018;2018:6832685. doi:10.1155/2018/6832685
Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F.Role of medical therapy in the management of uterine adenomyosis.Fertil Steril. 2018;109(3):398-405. doi:10.1016/j.fertnstert.2018.01.013
Kumar V, Chodankar R, Gupta JK.Endometrial ablation for heavy menstrual bleeding.Womens Health (Lond Engl). 2016;12(1):45-52. doi:10.2217/whe.15.86
Ma J, Brown B, Liang E.Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.Aust N Z J Obstet Gynaecol. 2021;61(2):290-296. doi:10.1111/ajo.13304
Ota Y, Ota K, Takahashi T, Suzuki S, Sano R, Shiota M.New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: a case report.Heliyon. 2020;6(8):e04628. doi:10.1016/j.heliyon.2020.e04628
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