Adenomyosis: Symptoms, Ultrasound Diagnosis and Treatment
Key message: Adenomyosis occurs when endometrial-type tissue is present within the uterine muscle. It can cause heavy painful…
Key message: Adenomyosis occurs when endometrial-type tissue is present within the uterine muscle. It can cause heavy painful periods, chronic pelvic pain and an enlarged tender uterus, but symptoms overlap with endometriosis and fibroids.
Get urgent help: Seek urgent care for very heavy bleeding with faintness or breathlessness, a positive pregnancy test with pain or bleeding, sudden severe pelvic pain, fever or rapid deterioration. New bleeding after menopause needs prompt assessment.
What is adenomyosis?
Endometrial-like glands and supporting tissue are found within the myometrium, causing inflammation and uterine muscle change. It may affect one area or be diffuse.
It is benign and is not the same condition as endometriosis, although both can coexist.
What symptoms can occur?
- Heavy or prolonged periods.
- Severe period pain.
- Chronic pelvic pressure or aching.
- Deep pain during sex.
- An enlarged, tender or bulky uterus.
- Anaemia symptoms from blood loss.
- No symptoms in some patients.
How is it diagnosed?
Imaging can strongly support the diagnosis, but the only absolute histological confirmation is after hysterectomy. Treatment does not need to wait for hysterectomy-level certainty.
- History and pelvic examination when appropriate.
- Transvaginal ultrasound as the usual first imaging test.
- MRI when ultrasound is unclear or detailed mapping will change treatment.
- Full blood count and iron studies when bleeding is heavy.
- Assessment for fibroids, endometriosis, polyps or another cause.
What medicines can help?
- A levonorgestrel-releasing intrauterine system when the uterine cavity is suitable.
- Combined hormonal contraception or progestogen-only treatment.
- Tranexamic acid during heavy bleeding when medically suitable.
- Anti-inflammatory pain medicine when not contraindicated.
- Selected GnRH-based treatment for a limited period under specialist care.
What if pregnancy is desired?
Hormonal suppression prevents conception while used, so pain control and fertility planning may need different strategies. Adenomyosis may be associated with reduced fertility or miscarriage in some patients, but many conceive.
A couple-based fertility assessment should consider age, ovarian reserve, semen, tubes and coexisting endometriosis or fibroids.
Which procedures may be considered?
- Uterine-artery embolisation or selected image-guided procedures in appropriate services.
- Adenomyomectomy for rare localised disease in highly selected patients, with significant uterine-scar and pregnancy implications.
- Hysterectomy as definitive treatment when symptoms are severe and future pregnancy is not desired.
- Endometrial ablation is not a fertility-preserving treatment and may be less effective when disease is deep in the muscle.
How is treatment chosen?
Choice depends on bleeding, pain, anaemia, age, contraception and pregnancy plans, coexisting disease, prior treatment and personal preference. No one treatment is best for everyone.
A symptom diary and review of response help avoid repeated ineffective treatment.
What happens around menopause?
Symptoms often improve after natural menopause as estrogen levels fall, but new or recurrent bleeding after menopause must not be assumed to be adenomyosis.
HRT can affect bleeding and should be reviewed through the postmenopausal-bleeding pathway when unexpected bleeding occurs.
Frequently asked questions
Is adenomyosis cancer?
No. It is a benign condition.
Is it the same as endometriosis?
No. Adenomyosis is within uterine muscle; endometriosis is outside the uterus, although they can coexist.
Can ultrasound diagnose it?
Modern transvaginal ultrasound can strongly support the diagnosis when performed and interpreted well.
Does it always require hysterectomy?
No. Many patients use medical or less invasive treatment.
Can I become pregnant?
Yes, although fertility may be affected in some patients and the full couple assessment matters.
Your next step
Bring a cycle and pain diary, blood results and previous scans. Treatment should be selected around symptoms and pregnancy plans rather than the scan label alone.
Medical and content review: Dr Mohamed Abdelghany, Obstetrics & Gynecology Specialist, MRCOG (UK), MSc Obstetrics & Gynecology – Kasr Al-Ainy, Cairo University.
Last reviewed: 23 August 2026.
This information is for general education and does not replace individual medical assessment.
