Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: 16 July 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
In Marathi, adenomyosis is usually called एडेनोमायोसिस (also written ॲडेनोमायोसिस) — गर्भाशयाच्या स्नायूंच्या भिंतीत गर्भाशयाच्या आतील अस्तरासारखे ऊतक आढळणे.
What is adenomyosis?
Adenomyosis is a benign uterine condition in which endometrial glands and stroma — tissue similar to the uterine lining — are present within the muscular wall of the uterus (the myometrium). It is one of the structural causes of abnormal uterine bleeding described by FIGO. Its exact cause is not fully understood, and symptoms overlap with other conditions, so it cannot be diagnosed from symptoms alone (Asian Society of Endometriosis and Adenomyosis, 2023; FIGO, 2018).
Adenomyosis can be diffuse (spread through the muscle wall) or focal, where a localised area is sometimes called an adenomyoma. Unlike a fibroid, a focal adenomyoma often has no clean edge or capsule, which is why it can be hard to distinguish on imaging. There is no universally accepted "stage 1–4" system for adenomyosis; imaging describes location, extent, and pattern rather than a fixed stage (ASEA, 2023; revised MUSA consensus, Harmsen et al., 2022).
Adenomyosis is benign — it is not cancer, and it does not turn into cancer. Symptoms often lessen after menopause, but this is not guaranteed, and any new bleeding or pain after menopause still needs evaluation for other causes (SOGC Guideline No. 437, 2023; NICE NG88).
What are the symptoms of adenomyosis?
The most common symptoms are heavy menstrual bleeding, significant period pain (dysmenorrhoea), chronic pelvic pain, pain during intercourse, and sometimes difficulty conceiving. Some women have no symptoms at all. Because these features overlap with uterine fibroids and endometriosis, no single symptom confirms adenomyosis (ASEA, 2023; NICE NG88).
A bulky, tender uterus alongside heavy and painful periods raises suspicion for adenomyosis, but a "bulky uterus" on a scan is a finding, not a diagnosis by itself — it can also relate to fibroids or other causes, and adenomyosis and fibroids can coexist (NICE NG88; MUSA, 2022). Heavy bleeding can contribute to anaemia and fatigue; NICE recommends a full blood count for anyone presenting with heavy menstrual bleeding (NICE NG88; WHO anaemia fact sheet).
It is worth arranging an evaluation when periods are progressively heavier or more painful, when bleeding or pain disrupts work, sleep, or daily life, when a scan reports a "bulky uterus" or "heterogeneous myometrium," or when there is difficulty conceiving. These symptoms connect to the wider pathway of heavy and painful periods. Seek urgent assessment for very heavy bleeding with fainting, marked dizziness or weakness, or breathlessness (ACOG heavy menstrual bleeding guidance).
How is adenomyosis different from fibroids?
Adenomyosis and uterine fibroids can both cause heavy, painful periods and an enlarged uterus, but they are different conditions — and they can occur together. Fibroids are discrete, well-defined benign muscle growths that can often be removed individually; adenomyosis is lining-like tissue spread within the uterine muscle itself, usually without a clean plane to excise. The two can be hard to tell apart on ultrasound, so assessment matters before planning care (ASEA, 2023; NICE NG88; MUSA, 2022).
| Feature | Adenomyosis | Uterine fibroids (leiomyomas) |
|---|---|---|
| What it is | Endometrial-like glands and stroma within the uterine muscle | Benign smooth-muscle growths of the uterus |
| Pattern | Often diffuse; may be focal (adenomyoma), often without a clean capsule | Usually discrete, well-defined masses (submucosal, intramural, or subserosal) |
| Uterus on examination | May feel globular, uniformly bulky and tender | May feel irregularly enlarged or distorted, depending on number and location |
| Symptoms | Heavy/painful periods, pelvic pain; may be asymptomatic | Heavy bleeding, pressure/bulk symptoms, pain; may be asymptomatic |
| Imaging approach | Transvaginal ultrasound first; MRI selectively if unclear | Pelvic ultrasound first; MRI selectively for extra detail |
| Uterus-sparing option | Selected medical or procedural care; diffuse disease cannot be simply "cut out" | A myomectomy can remove selected fibroids while keeping the uterus |
| Can both occur together? | Yes | Yes |
Sources: ASEA 2023; NICE NG88; revised MUSA consensus 2022; SOGC 2023. For more on fibroids, see uterine fibroids.
How is adenomyosis diagnosed?
Diagnosis begins with your menstrual and pain history, the impact on daily life, pregnancy and fertility goals, and a consent-led examination when appropriate. For heavy bleeding with significant period pain or a bulky, tender uterus, NICE recommends offering transvaginal ultrasound (TVUS) first, in preference to transabdominal ultrasound or MRI (NICE NG88, updated 7 July 2026).
TVUS and MRI are both useful, non-invasive tests. A structured meta-analysis reported pooled sensitivity and specificity of about 78%/78% for TVUS and 78%/88% for MRI, recommending ultrasound first-line and MRI when the picture is unclear — so MRI should not be called universally "the most accurate" (Tellum et al., Journal of Minimally Invasive Gynecology, 2020). Ultrasound features are read as a pattern rather than by any single phrase, and no single junctional-zone thickness cut-off should be used alone (MUSA 2022; SOGC 2023).
MRI is helpful when ultrasound is inconclusive or unsuitable, or when mapping a focal adenomyoma or coexisting fibroids. A hysterectomy specimen remains the definitive pathological confirmation, but contemporary practice can reach a clinical and imaging diagnosis without surgery. An endometrial biopsy does not diagnose adenomyosis, because the tissue lies in the muscle wall, not the cavity lining (SOGC 2023; ASEA 2023; NICE NG88).
Sex determination is illegal and is not performed here. Any pelvic ultrasound or MRI here is gynaecological imaging, not fetal sex determination.
What are the management options for adenomyosis?
There is no single "best" treatment for adenomyosis, and no medicine removes it from the muscle wall. The right approach depends on whether the main problem is bleeding, pain, anaemia, fertility, or several together — and on whether you wish to become pregnant or keep your uterus. A gynaecologist discusses the benefits, risks, alternatives, and effect on contraception or fertility so the plan fits your goals (NICE NG88; ASEA 2023).
| Goal / situation | What may be discussed | Important context |
|---|---|---|
| Reduce heavy bleeding and pain (not trying to conceive now) | A hormonal intrauterine system (LNG-IUS) is considered first when suitable; other options include tranexamic acid, NSAIDs, or hormonal methods | The LNG-IUS is contraceptive while in place; early bleeding-pattern changes are common and NICE suggests allowing about 6 cycles to judge benefit |
| Symptoms not controlled or method unsuitable | Alternative medical care, or short-term GnRH agonists in specialist settings | GnRH agonists are not for routine long-term use because of bone-density effects |
| Severe or refractory symptoms, family complete | Hysterectomy is the definitive option because it removes the uterus | It permanently ends the ability to carry a pregnancy; ovaries are a separate decision — it is not automatically first-line |
| Trying to conceive | Individualised fertility assessment (see below) | Endometrial ablation does not remove adenomyosis and pregnancy afterward is unsafe |
Suitability, contraindications, and dosing are decided by the clinician — this page does not recommend self-medication. Procedures such as uterine artery embolisation, HIFU, or conservative excision of focal disease are specialised, are not routine local services, and have limited evidence on later pregnancy; their availability here would need to be confirmed. There is also no reliable evidence that Ayurveda, diet, detox, or supplements cure adenomyosis — please disclose any remedies you use, as interactions are possible (NICE NG88; ASEA 2023; SOGC 2023). Adenomyosis care in Chandrapur is offered through our broader gynaecology care service.
Can I still get pregnant with adenomyosis?
Yes — pregnancy is possible. Adenomyosis is associated with reduced fertility and poorer assisted-conception outcomes at a group level, but this is not an individual prediction and it does not mean every woman needs IVF. Age, ovarian reserve, tubal and sperm factors, and coexisting endometriosis or fibroids all matter, and study definitions vary (ASEA, 2023).
A 2024 meta-analysis of IVF/ICSI comparisons reported, versus women without adenomyosis, roughly 26% lower odds of clinical pregnancy, 35% lower odds of live birth, and about 1.9-fold higher odds of miscarriage. These are pooled group associations, not any one person's predicted chance, and not outcomes for this clinic (Ge et al., BMJ Open, 2024). GnRH-agonist pre-treatment before embryo transfer has mixed evidence and may be considered selectively; the evidence is still evolving (Cozzolino et al., 2024).
Importantly, IVF is a fertility treatment — it is not a treatment for adenomyosis itself. Decisions follow a full assessment of the couple. If you are trying to conceive, IVF and fertility care can be discussed as one part of an individualised plan.