Condition Basics

What is adenomyosis?

Adenomyosis is a disease that occurs when the cells that normally line the uterus grow into the muscular tissue of the uterine wall. This can cause painful, heavy periods and chronic pelvic pain.

What causes it?

The cause of adenomyosis is not fully understood. Some researchers believe that it is the result of damage to the inner wall of the uterus during pregnancy, labour, delivery, or a surgical procedure.

What are the symptoms?

Sometimes adenomyosis does not cause any symptoms. But when symptoms are present, they can include:

• Heavy or prolonged menstrual periods (menorrhagia).
• Painful menstruation (dysmenorrhea).
• Chronic pelvic pain.
• Vague pelvic pain.
• Painful sexual intercourse.
• Feeling of pressure on the rectum or bladder.

How is it diagnosed?

When symptoms occur, the evaluation of suspected adenomyosis may include:

• History of symptoms, menstrual periods, and family history.
• Pelvic examination, which may reveal a large, soft, or tender uterus.
• A sample of the tissue of the wall of the uterus (endometrial biopsy).
• Pelvic ultrasound, which may help tell adenomyosis from other pelvic tumours.
• Hysteroscopy. This test allows the doctor to examine and take samples of the lining of the uterus.
• MRI of the pelvis.

But adenomyosis can only for sure be diagnosed when a pathologist examines the uterus after a hysterectomy.

How is adenomyosis treated?

Pelvic pain and heavy menstrual bleeding from adenomyosis can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and hormone therapy. A hysterectomy may be needed if you have severe symptoms but are not approaching menopause. Symptoms often go away after menopause is complete or after hysterectomy.

Other procedures may be tried to help relieve symptoms if medicine doesn't work and you don't want a hysterectomy. During these procedures, the doctor removes or shrinks adenomyosis in the uterus without removing the whole uterus.