Overview

Adenomyosis affects the uterus, also called the womb. It develops when tissue similar to the inner lining of the uterus grows into its muscular wall. During each menstrual cycle, this tissue responds to hormonal changes.

The uterus may become enlarged or tender, leading to heavy periods, painful cramps or pressure in the lower abdomen. Adenomyosis is not cancer. Some people don’t have any symptoms and don’t need treatment. For others, adenomyosis treatment depends on bleeding, pain, and future pregnancy plans. Past treatments also guide the next step.

At Sarvodaya Hospital, the best gynaecology hospital for adenomyosis, a gynaecology consultation can help patients assess their symptoms and discuss suitable care.

Adenomyosis Symptoms

• Heavy or longer periods, sometimes with clots
• Period cramps that disrupt daily activities
• Pain in the lower abdomen between periods
• A feeling of fullness, pressure or bloating in the lower abdomen
• Pain during sex
• Irregular bleeding or spotting between periods, though this is less common
• Tiredness or weakness if heavy bleeding has caused anaemia

Adenomyosis Causes

The exact causes of adenomyosis are unknown.

Possible explanations include:

• Growth into the Muscle: Cells from the inner lining may move into the uterine muscle.
• Hormonal Influences: Hormones involved in the menstrual cycle may support the growth of this tissue.
• Changes After Tissue Injury: Inflammation or healing within the uterus may play a part.
• Changes During Development: Cells similar to the uterine lining may become trapped in the muscle wall while the uterus develops before birth.

Risk Factors for Adenomyosis

The following factors are associated with a higher likelihood of adenomyosis, although it can occur without any of them:

• Age: It is more commonly diagnosed after age 30, particularly in the 40s.
• Previous Childbirth: People who have given birth are diagnosed with it more often.
• Previous Uterine Procedures: Surgery or other procedures involving the uterus may be associated with it.
• Endometriosis: Some people have both conditions. Endometriosis involves similar tissue growing outside the uterus.

Adenomyosis Diagnosis

For an adenomyosis diagnosis, the gynaecologist asks about periods, pain, previous treatment and pregnancy plans. They may examine the abdomen and, with the patient’s agreement, perform a pelvic examination.

Tests help look for signs of adenomyosis and check for other causes of bleeding or pain:

• Pelvic Examination: The gynaecologist checks whether the uterus feels enlarged or tender. This finding alone cannot confirm adenomyosis.
• Transvaginal Ultrasound: A slim ultrasound probe is placed in the vagina to create images of the uterus. It can show changes in the muscle wall and help identify other conditions, such as fibroids.
• Magnetic Resonance Imaging (MRI): This scan produces detailed images of the uterus. It may help when ultrasound findings are unclear or more detail is needed before treatment.
• Blood Tests: If periods are heavy, a blood count can check for anaemia, which means there are too few healthy red blood cells. Other tests depend on the symptoms.
• Endometrial Biopsy: In selected patients with abnormal bleeding, a small sample of the uterine lining may be tested to rule out other conditions. It does not confirm adenomyosis within the muscle wall.

Adenomyosis Treatment Options and Symptom Support

Adenomyosis treatment options depend on the severity of symptoms, other health conditions and future pregnancy plans. Someone without symptoms may only need a review if symptoms develop.

A gynaecologist for adenomyosis treatment can explain the likely benefits of each option, which may include:

• Pain Relief: Pain relievers help ease cramps and bleeding. Your doctor will make sure they are safe for your stomach and kidneys.
• Medicines for Heavy Bleeding: Tranexamic acid may reduce blood loss during periods. It helps control bleeding but does not remove adenomyosis.
• Hormonal Treatment: Hormonal pills or a hormonal intrauterine system, a small device placed inside the uterus, may make periods lighter and less painful. The choice depends partly on whether a pregnancy is planned for the future.
• Treatment for Anaemia: If heavy bleeding has lowered the blood count, iron treatment may be advised alongside treatment to control the bleeding.
• Uterine Artery Embolisation: In selected cases, a specialist passes a thin tube into a blood vessel and reduces blood flow to affected areas of the uterus. It may improve symptoms, but it is not suitable for everyone. Discuss its effect on future pregnancy with the doctor.
• Hysterectomy: This adenomyosis surgery removes the uterus. It may be considered when symptoms remain severe despite other treatments and the patient does not want to carry a future pregnancy. It cures adenomyosis, and periods stop after the surgery.

These approaches allow many people to try adenomyosis treatment without surgery first. The plan can be reviewed if symptoms persist or priorities change.

Benefits of Early Adenomyosis Treatment

Early assessment gives patients a chance to understand the cause of their symptoms and choose care that fits their needs.

It may help to:

• Reduce heavy bleeding and check for anaemia before it becomes more severe
• Manage cramps and pelvic pain that interfere with work, sleep or daily life
• Identify another condition that may also need treatment
• Discuss pregnancy plans before choosing hormonal treatment or surgery

Treatment can improve symptoms, but the response varies from person to person.

Complications if Left Untreated

Adenomyosis does not always worsen, and people without symptoms may not need treatment.

When heavy bleeding or pain continues, possible complications include:

• Anaemia: Ongoing blood loss can reduce healthy red blood cells, causing tiredness, weakness or shortness of breath.
• Persistent Pain: Cramps or pelvic pain may continue to affect sleep, activities and sex.
• Pregnancy Concerns: Some research links adenomyosis with fertility treatment difficulties and pregnancy problems. Many people with adenomyosis still become pregnant, and these problems can occur despite treatment.

Discuss these concerns, symptoms and pregnancy plans with a gynaecologist.

When Should You See a Doctor?

Book a gynaecology appointment if periods become heavier or more painful, pelvic pain keeps returning, or bleeding affects daily life. Seek assessment for bleeding between periods or after sex, as these symptoms should not automatically be attributed to adenomyosis.

Go to the nearest emergency department if you have:

• Very heavy bleeding along with fainting, severe dizziness or marked weakness
• Sudden, severe pelvic or abdominal pain
• Bleeding with severe pain or faintness when you are or could be pregnant

Sudden or severe symptoms may have another cause that needs urgent treatment.

Prevention & Lifestyle Modifications

There is no established way to prevent adenomyosis because its exact cause is unknown.

These steps can support adenomyosis management and make symptoms easier to discuss at appointments:

• Track Periods: Note bleeding, pain and how often period products need changing.
• Use Warmth for Cramps: A wrapped hot water bottle or heat pad on the lower abdomen may ease discomfort.
• Follow Medicine Advice: Ask which pain medicines are safe for you and take prescribed treatment as directed.
• Attend Follow-Up Visits: Tell the gynaecologist if bleeding or pain continues, or if pregnancy plans change.

Lifestyle measures may ease symptoms, but they do not remove adenomyosis.

Pre-Post Treatment Care

Pre-Treatment

• Bring a record of your periods, pain and any treatments already tried.
• Tell the gynaecologist if you are pregnant, may be pregnant or hope to conceive.
• Share your medicines, supplements, allergies and existing health conditions.
• Complete advised scans or blood tests, and ask how each result affects the plan.
• If a surgery is recommended, discuss recovery, possible risks and its effect on future pregnancy.

Post-Treatment

• Take medicines as prescribed and report side effects if any.
• Keep follow-up appointments so bleeding, pain and blood count can be reviewed.
• After a surgery, follow the specific advice given about rest, activity and wound care.
• Ask for reassessment if symptoms do not improve, return or become worse.
• Seek urgent care for heavy bleeding with faintness, sudden severe pain or other warning signs listed above.