Adenomyosis

Adenomyosis occurs when the endometrial tissue grows into the muscular wall of the uterus (myometrium). This tissue continues its usual cycle—thickening, breaking down, and bleeding each month. Over time, this can cause the uterus to enlarge, leading to painful, heavy periods. The condition is most common in women during their later reproductive years and often resolves after menopause when oestrogen levels decline.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG) | MRCOG (UK) | MMed (OBGYN) (SG)

Symptoms causes diagnosis treatments prevention FAQ

Symptoms of Adenomyosis

Symptoms of adenomyosis range from mild to severe, with some women experiencing mild discomfort while others have significant symptoms.

Heavy menstrual bleeding (menorrhagia): Periods may become unusually heavy, requiring frequent changes of sanitary products and sometimes containing large blood clots.
Prolonged menstrual bleeding: Menstrual periods may last longer than usual, often extending beyond seven days.
Severe cramping and pelvic pain: Menstrual cramps can become intense and worsen over time, sometimes radiating to the lower back or legs.
Pain during intercourse (dyspareunia): Discomfort or pain occurs during or after sexual activity due to pressure on the affected areas of the uterus.
Pelvic pressure and bloating: A feeling of fullness or pressure in the lower abdomen, along with bloating.
Enlarged uterus: The uterus may increase in size, causing discomfort or additional pressure on surrounding organs.
Fatigue and anaemia: Prolonged, heavy bleeding can lead to iron-deficiency anaemia, resulting in fatigue, weakness, and shortness of breath.

Causes and Risk Factors

Adenomyosis occurs when endometrial tissue infiltrates the myometrium. Several factors may increase the likelihood of its development.

Hormonal factors

Oestrogen is believed to play a role in adenomyosis growth. The condition often resolves after menopause when oestrogen levels decline.
Previous uterine surgery

Procedures such as caesarean delivery or fibroid removal may disrupt the boundary between the endometrium and myometrium, allowing endometrial cells to grow into the muscular layer.
Childbirth

Women who have given birth have a higher risk of adenomyosis than those who have never been pregnant.
Age

The condition is most commonly diagnosed in women in their 40s and 50s, particularly those who have had children.
Endometriosis

Adenomyosis often coexists with endometriosis, another condition where endometrial-like tissue grows outside the uterus.

Diagnostic Methods

Transvaginal ultrasound

This imaging test uses sound waves to examine the uterus. A probe inserted into the vagina captures detailed images of the uterine walls. Ultrasound can help identify signs of adenomyosis by showing an enlarged or altered uterus. However, it may not always be conclusive.

Magnetic Resonance Imaging (MRI)

MRI produces more detailed images than ultrasound, including clear images of uterine muscle changes. It is the most accurate non-invasive method for diagnosing adenomyosis.

Endometrial biopsy

This procedure removes a small tissue sample of the endometrium for laboratory examination. While this test does not confirm adenomyosis, it helps rule out other conditions with similar symptoms.

Hysteroscopy

A thin, lighted telescope (hysteroscope) is inserted through the vagina and cervix to examine the inside of the uterus. This procedure allows direct visualisation but is unable to detect adenomyosis in the uterine wall.

Histopathological examination

The definitive diagnosis is made by examining uterine tissue under a microscope after a hysterectomy, confirming the presence of endometrial tissue within the myometrium.

Treatment Options

Treatment varies based on symptom severity, age, and future pregnancy plans. Both medical and surgical approaches aim to relieve symptoms and improve quality of life.

Non-Surgical Treatment

Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce menstrual pain and heavy bleeding by lowering prostaglandin production.
Hormonal treatments: Contraceptives, such as the pill, patch, vaginal ring, or progestin-only options, help control bleeding and pain by suppressing endometrial growth and reducing menstrual flow. Levonorgestrel-releasing intrauterine devices (IUDs) provide localised hormone delivery.
GnRH agonists: These medications temporarily suppress oestrogen production, inducing a menopause-like state that shrinks adenomyosis tissue. Due to potential side effects, they are usually prescribed for short-term use.

Surgical Treatment

Endometrial ablation: Destroys the uterine lining using heat, cold, microwave energy, or radiofrequency. While it reduces bleeding, it does not treat deep adenomyosis and is unsuitable for those planning pregnancy.
Uterine artery embolisation: A minimally invasive procedure that blocks blood supply to adenomyosis tissue, causing it to shrink. A catheter is guided to the uterine arteries, where small particles are injected to reduce blood flow. Long-term fertility effects remain uncertain.
Hysterectomy: The surgical removal of the uterus is a definitive solution for severe cases. Types include:
- Total hysterectomy: removal of the uterus and cervix
- Subtotal hysterectomy: removal of the uterus only
- Radical hysterectomy: removal of the uterus, cervix, and surrounding tissue

This procedure is typically recommended when symptoms are severe and childbearing is no longer a concern.

Conservative surgery: In some cases, adenomyosis lesions can be surgically removed while preserving the uterus. These techniques, such as adenomyomectomy, are complex but may be considered for women wishing to maintain fertility.

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Prevention and Management

While adenomyosis cannot be prevented, certain lifestyle strategies may help manage symptoms.

Regular exercise may help regulate oestrogen levels and enhance well-being.
A diet rich in anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, may reduce pain and inflammation.
Heat therapy, including warm baths or heating pads, can provide temporary relief from cramping and pelvic discomfort.
Stress management techniques, such as meditation, yoga, or counselling, may aid in coping with pain.
Regular medical check-ups allow for monitoring and treatment adjustments as needed.

Frequently Asked Questions (FAQ)

Will adenomyosis resolve after menopause?

Adenomyosis usually improves or resolves after menopause when oestrogen levels decline. However, women undergoing hormone replacement therapy (HRT) may continue to experience symptoms.

How does adenomyosis differ from endometriosis?

Adenomyosis occurs when endometrial tissue grows into the muscular wall of the uterus, while endometriosis involves similar tissue growing outside the uterus. Both conditions cause painful periods and heavy bleeding but differ in their location and impact on fertility.

Can adenomyosis recur after treatment?

Non-surgical treatments manage symptoms but do not eliminate adenomyosis, so symptoms may return after discontinuation. Conservative surgical procedures also carry a risk of recurrence, whereas hysterectomy is the only definitive solution.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Lin has a clinical focus on female pelvic medicine and reconstructive surgery, encompassing the management of urinary incontinence, overactive bladder, and prolapse.

Dr. Lin completed his medical training at the National University of Singapore and obtained advanced certifications in Obstetrics and Gynaecology. He is a Member of the Royal College of Obstetricians and Gynaecologists in the UK.
Dr. Lin serves as a clinical tutor at NUS and contributes to laparoscopic and pelvic floor workshops. His research includes stem cell therapy, synthetic meshes, and translational medicine, with publications in peer-reviewed journals and textbooks.

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