Adenomyosis

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Adenomyosis is a condition that often flies under the radar, yet it affects many women — especially those in their 30s and 40s. It can cause heavy, painful periods and chronic pelvic discomfort, but because the symptoms can resemble other gynaecological issues, it’s frequently misdiagnosed or overlooked. Although it can be challenging to diagnose, effective treatments are available to manage symptoms and improve quality of life.

What is Adenomyosis?

Adenomyosis is a condition in which the tissue that normally lines the inside of the uterus (the endometrium) begins to grow into the muscular wall of the uterus (the myometrium). As a result, the uterus becomes enlarged, and the embedded tissue continues to thicken, break down, and bleed with each menstrual cycle.

This abnormal growth triggers inflammation in the surrounding muscle, leading to painful, heavy periods and often a feeling of pelvic pressure or bloating.

Adenomyosis is benign (non-cancerous) but can cause significant discomfort and disrupt daily life. It often occurs in women who have had children and is most common between the ages of 35 and 50, although it can also be found in younger or postmenopausal women.

What Are the Symptoms of Adenomyosis?

Symptoms can range from mild to severe, and not all women with adenomyosis experience noticeable issues. However, common symptoms include:

• Heavy or prolonged menstrual bleeding
• Severe menstrual cramps (dysmenorrhoea)
• Pelvic pain or pressure
• Pain during intercourse
• Chronic lower abdominal discomfort
• A feeling of fullness or bloating
• Enlarged, tender uterus felt during a pelvic exam
• Fatigue, especially related to anaemia from heavy bleeding

Because adenomyosis can mimic conditions like fibroids or endometriosis, proper diagnosis is important to receive the right treatment.

What Causes Adenomyosis?

The exact cause of adenomyosis isn’t fully understood, but several theories include:

• Invasive growth of endometrial cells into the uterine muscle layer
• Developmental origins during foetal formation of the uterus
• Uterine inflammation from childbirth, surgery (e.g., caesarean section), or infection
• Hormonal influence, particularly oestrogen, which appears to stimulate the growth of the abnormal tissue

Women with a history of multiple pregnancies or uterine procedures may be at higher risk, though the condition can develop without any clear cause.

How Is Adenomyosis Diagnosed?

Diagnosing adenomyosis can be challenging, as its symptoms overlap with those of fibroids, endometriosis, and other uterine conditions. Common steps in the diagnostic process include:

• Pelvic examination – The uterus may feel enlarged or tender
• Transvaginal ultrasound – Can detect changes in the uterine wall and exclude other conditions like fibroids
• MRI scan – More accurate in assessing the thickness of the uterine wall and identifying features of adenomyosis
• Histological confirmation – The only way to confirm adenomyosis with certainty is by examining the uterus after a hysterectomy, but this is not typically required for diagnosis

Diagnosis is often made based on symptoms and imaging findings combined with a detailed medical history.

When Should You See a Gynaecologist?

You should schedule a consultation if you experience:

• Heavy or painful periods
• Pelvic pressure, bloating, or discomfort
• Painful intercourse
• Unexplained fatigue or anaemia
• Difficulty conceiving
• An enlarged uterus found during a pelvic exam

How Is Adenomyosis Treated?

Treatment depends on the severity of symptoms, the patient’s age, and whether future fertility is a consideration. Options include:

1. Lifestyle Measures and Supportive Care

• Heat therapy (heating pads) to relieve cramping
• Anti-inflammatory medications such as ibuprofen for pain relief
• Iron supplements if heavy bleeding has caused anaemia

2. Hormonal Treatments

These can help regulate periods and reduce bleeding and pain:

• Combined oral contraceptive pills
• Hormonal IUD (e.g., Mirena)
• Progestin-only pills or injections
• GnRH agonists to temporarily suppress menstruation

Hormonal options often provide good symptom relief, especially for women not planning pregnancy.

3. Surgical Options

• Endometrial ablation – Removes the lining of the uterus to reduce bleeding; not suitable for women who wish to conceive
• Uterine artery embolisation (UAE) – Blocks blood supply to affected areas, shrinking adenomyotic tissue; more commonly used for fibroids but may be effective in selected cases
• Hysterectomy – The only definitive cure, removing the uterus completely. Considered for severe, treatment-resistant cases in women who have completed their families

Each treatment approach is personalised, and your doctor will guide you in choosing the most suitable option for your goals and symptoms.

Can Adenomyosis Affect Fertility?

Yes, it can. Although not all women with adenomyosis have fertility issues, the condition has been associated with:

• Impaired implantation of embryos
• Increased risk of miscarriage
• Lower success rates in assisted reproductive technologies (e.g., IVF)

Women trying to conceive may need specialist fertility support. Treatment options can be tailored to preserve fertility where possible.