What is adenomyosis?
Adenomyosis is a condition in which the inner lining of the uterus starts to grow into the muscular wall of the uterus. This can make the uterus larger and cause heavy periods, cramps, and pelvic pain. The abnormal tissue still reacts to hormonal changes during the menstrual cycle, which can worsen pain and bleeding.
Some people may not notice symptoms at first, while others experience discomfort that affects daily life. Adenomyosis can sometimes influence fertility, but the effects vary depending on the severity and individual factors.
Differences and similarities between adenomyosis and endometriosis
The main difference between adenomyosis and endometriosis is that in endometriosis the tissue grows outside of the uterus.
Both metaplasia conditions, meaning the diseased cells change when they invade new organs. In the case of adenomyosis, this causes abnormal uterine cell growth. Due to these similarities, doctors often refer to adenomyosis as the “sister” disease of endometriosis.
Symptoms of adenomyosis
Like many other diseases, some patients can have adenomyosis, yet have no symptoms at all. Others can experience debilitating pain and heavy bleeding.
Other symptoms of adenomyosis include:
- painful periods and cramps
- heavy menstrual bleeding that includes clots
- painful bowel movements
- bladder symptoms, including uncomfortable urination, burning sensation during urination, or blood in the urine
- peripheral nerve numbness or weakness, which can cause leg or bowel pain during periods
- pain during intercourse
- inflammation of the uterus causing swelling in the abdomen
- deficiency in blood cells or hemoglobin
What causes adenomyosis?
In the last decade, an increasing number of studies have identified various causes for adenomyosis. These include sex hormone receptors, inflammatory molecules, extracellular matrix enzymes, growth factors, and neuroangiogenic factors.
There are many theories surrounding adenomyosis that continue to evolve. Below is a summary of current theories:
- Prior uterine surgery or childbirth causes inflammation of the uterine lining that might cause a break in the healthy boundary of cells lining the uterus. Surgical procedures on the uterus can have a similar effect.
- Tissue trauma or any vaginal injury that allows inflammation can lead to macrophages and cytokines migrating into the myometrium
- High expression of estrogen receptors can stimulate migratory tissue into the myometrium.
- Myometrium cells can spread and build up through the lymphatic system or through stem cells.
- Various hormones including estrogen, progesterone, prolactin, and the follicle-stimulating hormone may trigger the condition.
Adenomyosis belly
Adenomyosis belly refers to the severe abdominal distension caused by the physical enlargement of the uterus. Unlike standard bloating, this happens because the uterine wall thickens and becomes “boggy” or bulky. In severe cases, the uterus can triple in size, pushing the lower abdomen outward like a pregnancy bump.
This distension typically feels hard and tender to the touch, rather than soft or squishy. It is often triggered by inflammation and blood pooling in the uterine muscle during your cycle. The swelling is usually most visible right before and during menstruation.
Factors increasing the risk of adenomyosis
There are several factors that may increase the risk of adenomyosis. These are:
- age with 70 to 80 % of women undergoing hysterectomy for adenomyosis being in their 40s and 50s
- giving birth to two or more babies at the same time or having borne a number of children
- smoking
- ectopic pregnancy
- depression and antidepressant use
Get a Second Opinion
Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (212) 988-1444 or have your case reviewed by clicking here.
Diagnosing adenomyosis
Pathology
Pathology has always been considered the gold standard to make the final diagnosis of adenomyosis. Generally, women having hysterectomies would have the tissue removed and examined under a microscope by a pathologist.
Imaging techniques
Diagnosing adenomyosis often involves imaging techniques that help visualize the uterus and detect signs of the condition. The two most commonly used imaging methods are transvaginal ultrasound and magnetic resonance imaging (MRI). Transvaginal ultrasound is typically the first-line imaging tool.
Ultrasound is also highly accurate if performed by an expert sonographer. It can show cysts within the uterine muscle, revealing suspected adenomyosis. An ultrasound can provide substantial enough evidence for an experienced doctor to identify the condition, with a sensitivity rate of 83% and a specificity rate of 85%.
There are also minimally invasive techniques such as historiography, hysteroscopy, cystoscopy, and laparoscopy.
Adenomyosis types
Adenomyosis can be classified into two main types: focal and diffuse. Focal adenomyosis occurs when endometrial tissue is confined to a specific area of the uterus, creating localized lesions. In contrast, diffuse adenomyosis involves widespread infiltration of the uterine muscle, affecting a larger portion of the uterus.
Both types lead to similar symptoms, such as pain and heavy bleeding, but the severity can vary. Focal adenomyosis may be more easily treated, while diffuse adenomyosis can be more challenging and may require more extensive treatment, such as surgery.
Living with adenomyosis
If you’re living with adenomyosis, learning what to avoid can genuinely make a difference in how you feel. It’s really about being mindful of inflammatory and hormone-disrupting substances. Take highly processed foods packed with refined sugars and artificial additives, for example.
Similarly, limiting your intake of caffeine and alcohol is a pretty smart move. Both of these can actually trigger heavier bleeding and make you feel more sensitive to pain.
Adenomyoma vs adenomyosis
Adenomyoma and adenomyosis are related but different conditions affecting the uterus. Adenomyosis occurs when the inner lining of the uterus grows into the muscular wall. This often causes heavy periods, pelvic pain, and a generally enlarged uterus.
Adenomyoma, on the other hand, is a localized form of adenomyosis. It appears as a distinct, firm mass within the uterine wall. While both can cause similar symptoms, adenomyoma tends to be more focal, and sometimes it can be mistaken for fibroids on imaging. Diagnosis usually relies on ultrasound or MRI, and treatment depends on symptom severity and reproductive plans.
Does adenomyosis affect pregnancy?
Yes, adenomyosis can affect pregnancy, although the impact varies from person to person. Some women with adenomyosis conceive and carry pregnancies without complications, while others may face challenges.
Adenomyosis can interfere with embryo implantation due to changes in the uterine lining and muscle wall. Inflammation caused by adenomyosis may also impact hormone balance and egg quality, further affecting fertility.
According to research results presented at the Japan Society of OB/GYN, patients with adenomyosis have a miscarriage rate of 50%, a pre-term birth rate of 24.4%, and a fetal retardation rate of nearly 12%.
Disorders associated with adenomyosis
- About 40 to 50% of patients with adenomyosis also have endometriosis. One in five patients diagnosed with endometriosis after age 30 have adenomyosis or have an increased risk of developing the disease.
- 50% of patients with adenomyosis also have fibroids.
- Patients with adenomyosis often also have anemia, or a deficiency in blood cells or hemoglobin, which results in pallor and a weak appearance.
Treatment of adenomyosis
Surgical treatment
The only way to treat adenomyosis is uterine surgery. The preferred surgical method is laparoscopic deep excisional adenomyosis surgery (LEAS). The aim is to prevent the removal of the uterus. Requiring extreme skill in meticulous suturing, uterine muscles need to be reconstructed layer by layer to allow a future pregnancy.
In cases adenomyosis is confined to one wall, another conservative technique that could be performed is the Osada procedure, named after the Japanese surgeon who developed it.
Alternative surgical methods are hysterectomy or partial hysterectomy. This is when the surgeon removes the whole uterus or part of it.
Non-surgical treatment
The symptoms of the disease can also be managed non-surgically. The right method for each patient depends on the seriousness of their condition.
Many of the medications approved for and used by endometriosis patients can also be used to treat adenomyosis. However, while some patients experience pain relief by taking birth control pills, others do not.
If bleeding is a patient’s primary symptom, birth control pills and/or IUDs may be helpful. The side effects of each medication should be considered, as patients react differently to different medications. Also note that hormonal treatments do not treat adenomyosis, but only manage menstrual cycles.
One method not recommended for treating adenomyosis is uterine artery embolization.
FAQs
What should you do if you have adenomyosis?
Schedule an appointment with a gynecologist for accurate diagnosis and personalized care.
Track your menstrual cycle and symptom severity to inform treatment decisions.
Discuss pain relief options, such as NSAIDs and heating pads, to manage cramps.
Explore medical therapies (e.g., birth control pills, IUDs) to reduce heavy bleeding.
Implement anti-inflammatory lifestyle changes, including diet adjustments and gentle exercise.
Consider fertility planning or referral to a reproductive specialist if you wish to conceive.
Seek emotional support through counseling or support groups to address stress and anxiety.
Attend regular follow-up visits to monitor treatment effectiveness and adjust as needed.
Can adenomyosis go away on its own?
Wouldn’t it be great if adenomyosis was just something that magically disappeared on its own? Sadly, that’s usually not the case. That abnormal endometrial tissue, which has decided to embed itself within the muscular wall of your uterus, tends to stick around until there are significant hormonal shifts or medical interventions.
The core of this condition lies in the cyclical growth and shedding of these endometrial cells inside the myometrium. This means that, without treatment, that misplaced tissue just keeps existing, and, unfortunately, your symptoms often persist.
Throughout a woman’s reproductive years, estrogen acts like a fuel for this misplaced tissue, affecting it in the very same way it affects the normal uterine lining. This leads to that monthly bleeding, inflammation, and pain. Since hormonal fluctuations are a natural part of our menstrual cycle, those “out-of-place” cells keep responding; they don’t just decide to pack up and leave on their own. So, while we wish it would, adenomyosis doesn’t typically just resolve itself.
What is the best treatment for adenomyosis?
The only definitive cure for adenomyosis is a hysterectomy (removal of the uterus). However, the “best” treatment for you depends entirely on whether you wish to preserve your fertility. For symptom management without major surgery, hormonal IUDs (like Mirena) are often the first line of defense. They release progestin directly to thin the uterine lining and significantly reduce heavy bleeding. If you want to avoid a hysterectomy but need stronger relief, Uterine Artery Embolization (UAE) is a powerful alternative.
What happens if you don’t treat adenomyosis?
If adenomyosis is not treated, symptoms can gradually worsen over time. Many people experience increasingly heavy menstrual bleeding, which can lead to anemia and fatigue. Pain during periods or even daily discomfort may intensify, affecting quality of life and limiting normal activities. The uterus can become enlarged, causing pressure or bloating in the lower abdomen.
How can I cure my adenomyosis without surgery?
You cannot completely cure adenomyosis without surgery, but symptoms can be managed effectively with certain approaches. Hormonal treatments, such as birth control pills, hormonal IUDs, or other hormone therapies, can help reduce heavy bleeding and lessen period pain. Anti-inflammatory medications can relieve cramps and pelvic discomfort.
Lifestyle adjustments, including regular exercise, a balanced diet, and stress management, may also reduce symptom severity. While these methods control symptoms, they do not remove the adenomyosis itself, so long-term monitoring is often necessary to adjust treatment as symptoms change.
Should I be worried about adenomyosis?
You do not need to panic if you have adenomyosis, but it is important to monitor your symptoms. The condition is benign, meaning it is not cancerous, but it can cause heavy periods, pain, and sometimes fertility challenges. Paying attention to changes in bleeding, pelvic discomfort, or other symptoms can help you manage it effectively.
Early medical guidance can provide treatments to control symptoms and maintain quality of life. Regular check-ups are useful to track the condition and prevent complications like severe anemia from prolonged heavy bleeding.
How i cured my adenomyosis?
You can manage adenomyosis with medication, hormonal therapy, or surgery depending on symptom severity and fertility goals.
Many people start with pain relievers (like NSAIDs) to reduce cramps and discomfort. Hormonal treatments such as birth control pills, IUDs, or GnRH agonists help regulate or reduce menstrual bleeding and pain. For those done with childbearing or with severe symptoms, surgical options like endometrial ablation or hysterectomy may be recommended.
Can adenomyosis cause leg pain?
Yes, adenomyosis is a surprising but frequent cause of chronic leg and hip pain. As the disease progresses, the uterus becomes bulky and enlarged, sometimes doubling or tripling in size. This heavy, inflamed organ exerts immense pressure on the pelvic nerves, specifically the sciatic nerve. The resulting pain often radiates from the lower back down through the buttocks and into the thighs. Patients describe it as a heavy “dragging” sensation or a shooting ache that worsens during menstruation.
What foods trigger adenomyosis?
Foods that trigger adenomyosis are primarily those that promote chronic inflammation and elevate estrogen levels. Since this condition thrives on estrogen, you should strictly limit red meat and high-fat dairy products. These foods often contain hormones that can disrupt your natural cycle and worsen symptoms. Gluten and refined sugars are also major culprits, as they spike insulin and increase pain-causing chemicals called prostaglandins. Additionally, excessive caffeine and alcohol can aggravate pelvic congestion, leading to heavier bleeding and more severe cramping.
You can also find the related scientific articles on adenomyosis below:
- Adenomyosis : Early Diagnosis is Essential in Adolescence
- Adenomyosis as a Barrier to Effective Surgery for Dyspareunia in Rectovaginal Endometriosis
- The Role of Uterine Contractility in Endometriosis and Adenomyosis
Our approach
Unlike many gynecological surgeons, surgeons at the Seckin Endometriosis Center do not always view hysterectomy as the universal treatment for adenomyosis. In fact, we believe that too many patients undergo unnecessary hysterectomies.
Hysterectomy as a last resort
In cases of focal adenomyosis or adenomyoma, the team will advise a minimally invasive approach avoiding large scar laparoscopic deep excision surgery before a hysterectomy. Only in cases of advanced adenomyosis will Dr. Seckin perform a hysterectomy, because in these cases the abnormal tissue has spread throughout and the uterus is beyond repair.
B) The bed of tissue where the adenomyoma was once implanted within.
C) The uterus is sutured and repaired in order to restore uterine function.
Removing the uterus with a hysterectomy doesn’t solve all the co-morbidities associated with adenomyosis because nearly 50% of women diagnosed have lesions outside the uterus. A hysterectomy alone addresses neither peritoneal endometriosis nor deeply infiltrating lesions that may associate with the bowel, bladder, ureter, and retroperitoneal fibrosis causing neuropathy.
A hysterectomy also has its limitations when treating adenomyosis that involves peritoneal endometriosis and deep infiltrating lesions related to the bowel, bladder, ureter, and retroperitoneal fibrosis. Patients will also need to have laparoscopic excision surgery to remove the lesions outside of the uterus.
At the Seckin Endometriosis Center, we have a deep respect for the personal journey that comes with deciding to have a hysterectomy.
Patient story
Amy O. was 39 years old when she came to Dr. Seckin. She had heavy periods and severe cramping since age 12 and received a diagnosis of endometriosis and adenomyosis at age 29, after having four different surgeries. After a 27-year battle with her disease, Amy received her final surgery in July 2016. Read more about how Amy feels now.
You can read more patient stories in our testimonial section.
Get a Second Opinion
Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (646) 960-3080 or have your case reviewed by clicking here.
Dr. Seckin is an endometriosis specialist and women’s reproductive health advocate. He has been in private practice for over 30 years at Lenox Hill Hospital with a team of highly skilled personnel.
Dr. Seckin specializes in advanced laparoscopic procedures and is recognized for his expertise in complex cases of deep infiltrating endometriosis of the pelvis. He is particularly dedicated to performing fertility-preserving surgeries on cases involving the ovaries.
He has developed patented surgical techniques, most notably the “Aqua Blue Excision” technique for a better visualization of endometriosis lesions. His surgical techniques are based on precision and microsurgery, emphasizing organ and fertility preservation, and adhesion and pain prevention.
Dr. Seckin is considered a pioneer and advocate in the field of endometriosis.