Adenomyosis: what it is, how it affects fertility, and how it is treated
Adenomyosis is a common condition in which tissue like the lining of the womb grows into the womb's muscular wall. The wall thickens, often causing heavier, more painful periods. It can sometimes make conceiving harder, but many women with adenomyosis do have children. Dr Mayur Pai explains the symptoms, the diagnosis and the treatment options.
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Why do periods keep getting heavier and more painful?
Many women tell us that their periods have slowly become heavier and more painful over the years, with a constant, dragging heaviness low in the abdomen. If that sounds familiar, there is often a clear and manageable reason for it, and one common cause is adenomyosis. Once you understand it, it becomes much easier to live with and to manage.
What is adenomyosis?
The womb, or uterus, has a thick muscular wall and a soft inner lining that builds up and sheds each month as your period. In adenomyosis, tissue similar to that lining starts to grow inside the muscular wall itself.
Every month, this tissue responds to your hormones, just as the lining does. But because it is trapped within the muscle, it has no easy way to leave. Over time the wall of the womb thickens, and the womb becomes bulky and tender. This is what leads to heavy, painful periods.
Adenomyosis is related to endometriosis, in which similar tissue grows outside the womb, and the two can occur together. It is also different from fibroids, which are separate lumps of muscle tissue, although fibroids and adenomyosis can exist side by side.
What are the symptoms of adenomyosis?
The symptoms we most commonly see are:
- periods that are heavier than your own usual;
- period pain that has slowly worsened over the years;
- a deep, dragging heaviness low in the abdomen;
- cramping that begins before the period and carries on through it;
- for some women, pain during intercourse.
On examination, and on a scan, the womb often looks bulky and enlarged. Every woman is different: you may notice many of these, or only one or two.
Does adenomyosis affect fertility?
Many women ask this, and it is an important question. Adenomyosis can sometimes make it harder to conceive, and in pregnancy it may mean we watch over you a little more closely. But please hear this clearly: many women with adenomyosis do go on to have children.
There are treatments that can help, and there are further steps in fertility care that we can offer when they are needed, such as IVF. If you are trying for a baby, we also look at the rest of the fertility picture, for both partners, so that nothing is missed; our guide to the common causes of infertility explains what else is checked. So please do not lose hope.
How is adenomyosis diagnosed?
It begins with a simple, unhurried conversation about your periods, your pain and how all of this affects your daily life. Then a gentle examination. After that, an ultrasound scan, which can show the thickened, bulky wall of the womb.
In some cases we advise an MRI scan. It gives a clearer picture and helps us tell adenomyosis apart from other conditions, such as fibroids, which can sometimes exist alongside it.
How is adenomyosis treated?
There is more than one path. Which one suits you depends on your age, your symptoms and your plans for a family, and it is a decision we make together.
Medicines
For many women, we begin with medicines. Some help settle the hormonal cycle and quieten the monthly stimulation of this tissue. Others ease the pain, and others control heavy bleeding. Each one is chosen for your situation, and we always explain what a medicine does before you begin.
Procedures
For some women, a procedure may be more suitable than medicines alone. Whether one is needed, and which, depends on your symptoms and on whether you still hope to have a child.
If you are hoping for a baby
If you are hoping to have a child, we plan everything with your fertility in mind, so that easing your symptoms fits with your plans for a family.
What does getting help look like?
Here is a composite picture, drawn from many women rather than any one person. A woman in her late thirties comes to us because, over several years, her periods have become much heavier and far more painful than before, with a constant heaviness in her lower abdomen. A scan shows a bulky womb. Once we understand the condition properly and begin the right approach for her, her symptoms settle and her life moves forward.
Do you just have to put up with it?
No. If there is one thing to take away, it is this: heavy, painful periods that keep getting worse are not something you simply have to put up with. Adenomyosis is common, it is well understood, and it can be managed. You do not have to carry it alone.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so the consultation, the scans, any procedure and any fertility treatment happen in one place, under one team. Free patient transport is available from across Goa and nearby areas.
Getting started
If you have a concern, or would simply like to understand your own situation better, send a WhatsApp message to +91 95185 02773. Consultations are by appointment, so please call reception on +91 95459 20817 to book a time. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
Is adenomyosis the same as endometriosis?
No, but they are related. In adenomyosis, tissue like the womb lining grows into the muscular wall of the womb; in endometriosis, similar tissue grows outside the womb. The two can occur together.
Can I get pregnant if I have adenomyosis?
Many women with adenomyosis do go on to have children. It can sometimes make conceiving harder, and a pregnancy may be watched a little more closely. Treatments can help, and further fertility care, such as IVF, can be offered when it is needed.
How is adenomyosis diagnosed?
With a conversation about your periods and pain, a gentle examination and an ultrasound scan, which can show the thickened, bulky wall of the womb. Sometimes an MRI scan is advised for a clearer picture, and to tell adenomyosis apart from fibroids, which can exist alongside it.
Can adenomyosis be treated with medicines?
Often, yes. For many women, treatment begins with medicines: some settle the hormonal cycle and quieten this tissue, and others ease pain or control heavy bleeding. For some women a procedure may be more suitable. The choice depends on your age, your symptoms and your plans for a family.
When should I see a doctor about heavy, painful periods?
When your periods have become heavier or more painful than your own usual, when the pain has been getting worse over the years, or when it affects your daily life. These are not things you simply have to put up with. A consultation and a scan are usually the first steps.
Or call +91 95185 02773
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.