Adenomyosis: what is it and how does it differ from endometriosis?

Statistics show that as many as 1 in 10 women in the UK suffer from adenomyosis, a painful condition of the uterus which can often be confused with endometriosis. Revered consultant obstetrician and gynaecologist Dr Shazia Malik explains the condition, including symptoms, treatment options and how it can be diagnosed.

What is adenomyosis?

Adenomyosis is a medical condition that predominantly affects the uterus. It mainly affects the myometrium, which is the muscle of the uterus.

What happens is that the uterus tissue lining starts to grow into the muscular wall of the uterus and can affect either part of the womb or the whole womb.  

What are the symptoms of adenomyosis?

Some women have adenomyosis without realising it because they are not displaying or experiencing any symptoms.

Those who do display signs of the condition may experience symptoms such as:

• Bloating.
• Severe period pain.
• Prolonged, heavy periods.
• Pain during sex.
• A feeling of strong pressure on the stomach, which is heightened before and during periods.

What are the treatment options for adenomyosis?

The choice of treatment for adenomyosis will depend on the patient’s symptoms, in particular the severity of such symptoms and how they are affecting the woman’s life.

For mild symptoms, treatment can be as simple as an over-the-counter pain medication or things such as heated pads, which reduce the pain which occurs due to the cramps and inflammation caused by the condition. However, for more severe cases, hormone therapy is the recommended option, because oestrogen plays a huge role in adenomyosis. For this reason, the condition typically affects women during their reproductive years and may cease after they go through menopause when oestrogen levels naturally drop.

Other options to treat the condition include the contraceptive pill or levonorgestrel-releasing IUD (the hormone coil), as well as the mini pill or implant. Some doctors may recommend the use of a uterine artery embolisation (UAE). This works to eliminate blood supply to the areas affected by adenomyosis and may be suggested when all other treatments fail.

A hysterectomy may be considered in extreme cases of adenomyosis.

What is the difference between adenomyosis and endometriosis?

There can be confusion between adenomyosis and endometriosis because the symptoms of both conditions can be very similar, including heavy periods and excruciating cramps

However, the fundamental nature of both conditions is different. Endometriosis is a result of the cells which line the uterus growing outside of it, which causes damage to the ovaries and the fallopian tube and can lead to fertility issues.

On the other hand, adenomyosis occurs due to the cells of the uterus lining growing into the muscular wall of the uterus. With adenomyosis, the inside of the womb becomes larger and thicker, which does not occur with endometriosis.

Why does adenomyosis often go undiagnosed?

Unfortunately, adenomyosis can often go undiagnosed not only due to lack of research and awareness but also because it can be extremely difficult to identify.

It can also be confused with conditions such as endometriosis, irritable bowel syndrome (IBS) or pelvic inflammatory disease because of symptoms which can be inherent to these conditions, such as painful periods.

Furthermore, during an ultrasound, adenomyosis can be misdiagnosed because uterine fibroids, which are often produced by adenomyosis, can obscure the ultrasound’s vision of the condition.

How can I get a diagnosis?

It is essential to book an appointment with your GP if you are experiencing symptoms of adenomyosis so that they can consider a diagnosis.

During the consultation, the doctor will perform a pelvic examination to establish if the uterus is enlarged or tender to the touch. This assessment will also look at the vulva, cervix and vagina and attempt to determine the underlying cause of the symptoms. 

Following this examination, if the doctor believes that you are suffering from adenomyosis, they may carry out a transvaginal ultrasound, which can produce moving images of the uterine and pelvic anatomy, helping to diagnose the condition.

The features of the ultrasound can display thickening of the endometrium and myometrium and have the ability to determine if there are any concomitant endometriosis outside the womb in the pelvis.

If you suspect that you have adenomyosis and would to speak to book a consultation with Dr Malik, do not hesitate to visit her Top Doctors profile today.