By Dr. Sharon R. Hontiveros
What is adenomyosis?
Adenomyosis occurs when tissue that normally lines the uterus is present within its muscular wall. It can enlarge the uterus and cause painful or heavy periods.
Symptoms to watch for
- Intense menstrual cramps.
- Heavy or prolonged periods.
- Pain during intercourse.
- Persistent pelvic pain.
- A feeling of pressure, heaviness, or fullness in the lower abdomen.
Some women have mild symptoms or none at all. Others find that pain and bleeding interfere with work, relationships, and daily activities.
What causes it?
The exact cause remains uncertain. Estrogen plays a role, and previous uterine surgery, such as a C-section or fibroid removal, is a recognized risk factor. These associations do not mean that surgery always causes adenomyosis.
How is it assessed?
Your OB-GYN will review your symptoms and may perform a pelvic examination. Ultrasound, and sometimes MRI, can help assess the uterus and distinguish possible causes of symptoms.
Symptoms can overlap with fibroids and endometriosis, and these conditions may occur together. Adenomyosis affects the uterine muscle; endometriosis involves similar tissue outside the uterus.
Treatment options
Treatment depends on symptom severity, your preferences, and plans for pregnancy. Options may include:
- Anti-inflammatory medicines for pain.
- Medicines such as tranexamic acid to reduce heavy bleeding when suitable.
- Hormonal treatments, including a hormonal intrauterine system or other hormonal contraception, to help control pain and bleeding.
- Hysterectomy, or removal of the uterus, when symptoms remain troublesome and other treatments are unsuitable or have not helped.
Hysterectomy is a definitive treatment for adenomyosis, but it is major surgery and means you can no longer carry a pregnancy. Tell your doctor if you hope to conceive so your care plan reflects that goal.
When to seek care
Discuss heavy or prolonged bleeding, persistent pelvic pain, or symptoms affecting daily life with your OB-GYN. Heavy bleeding can lead to anemia, so mention tiredness or breathlessness too.
Seek urgent assessment if pelvic or period pain is severe or worse than usual and pain relief has not helped.
Many women find meaningful relief with appropriate treatment. You do not have to accept disabling pain or heavy bleeding as your normal—an assessment can help you understand your options.
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