Pelvic Pain

Adenomyosis

Information about adenomyosis.

What is adenomyosis?

Adenomyosis is similar to endometriosis; it used to be called ‘endometriosis interna’.  Like endometriosis, the lining of the womb (the endometrium) is found where it should not be.  In adenomyosis, the endometrium grows in the muscle layer below (the myometrium).

The misplaced endometrium cannot bleed as normal, as it is trapped in the muscle layer. This is associated with heavier bleeding and pelvic pain.


How common is adenomyosis?

This is not known, although it’s found in up to 40% of hysterectomy specimens when they are examined in the laboratory.  Adenomyosis is associated with endometriosis and fibroids.

Adenomyosis can affect a woman at any age, although it’s most commonly diagnosed in middle-aged women who’ve had children.


What are the symptoms of adenomyosis?

  • Excessive pain before/during/after periods
  • Abnormal heavy bleeding
  • Pain when having sex
  • Fertility problems

What is thought to cause adenomyosis?

Adenomyosis is oestrogen-dependent, but why it occurs is unknown.


How is adenomyosis diagnosed?

Adenomyosis is difficult to diagnose.  Some patients may experience few or no symptoms. Ultrasound is unhelpful but MRI (Magnetic Resonance Imaging, which produces detailed images of the inside of the body) can be used to identify disease.


How is adenomyosis treated?

Medical treatment is aimed at controlling the excessive pain before/during/after periods and the abnormal bleeding.

The progesterone intrauterine system (IUS) or the combined oral contraceptive pill (COCP) or Depo-Provera or a GnRH agonist (e.g. DecapeptylTM) +/- non-steroidal anti-inflammatory drugs (NSAIDs e.g. ibuprofen), may control these.

However, hysterectomy (surgical removal of the womb) is sometimes required.  Hysterectomy is normally curative.