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If you have heavy bleeding and painful periods, you may think you have endometriosis. But after examining you, your doctor says you have adenomyosis. But what’s adenomyosis?

If you’ve never heard of adenomyosis, it’s a gynecological health issue caused by abnormal growths inside the wall of the uterus. For some, this disease causes an enlarged uterus.

Adenomyosis is similar to endometriosis in that it can also cause heavy period bleeding, pelvic pain, and other symptoms. This disease often co-occurs with its better-known cousin.

Adenomyosis vs. Endometriosis

Though adenomyosis and endometriosis, or “endo,” are distinct health issues, they’re closely related. Experts think that the two diseases may share a common origin.

Both issues seem to stem from abnormal cells in the lining of the uterus. During each menses, the uterus sheds these cells through period blood.

Some people carry genetic changes that cause these cells to behave atypically. In both health issues, the cells implant in places they don’t belong:

• In adenomyosis, the cells get trapped in the muscle layer of the wall of the uterus. They implant and multiply there, creating noncancerous tumors.
• In endometriosis, the cells travel out of the uterus into the abdomen. When they get there, they implant and grow on other organs such as the ovaries, intestines, and bladder. They can also grow on the layers of tissue around the organs.

In both cases, these cells cause abnormal reactions to sex hormones. The cells trigger the body to make too much estrogen. The cells also become less sensitive to progesterone, another sex hormone.

What causes adenomyosis?

Research into the causes of these diseases is ongoing. Scientists have several theories about what causes these health issues. These include genetic and environmental factors.

Genetics

Scientists think people may inherit these diseases but aren’t sure how. Our environment may also affect genes. These factors can affect whether someone with a genetic risk gets endometriosis.

Though these diseases are distinct health issues, both involve changes in similar genes. This link supports the theory that gene changes can lead to one or both of these health issues.

Environmental endocrine-disrupting chemicals

Chemicals called endocrine disruptors may partly explain the origins of endometriosis and adenomyosis. Chemicals such as parabens, phthalates, and bisphenol A (BPA) can disrupt the human endocrine system.

Exposure to these chemicals may affect how these diseases evolve. Research on endocrine disruptors is still in progress.

The endometriosis-to-adenomyosis pathway

These diseases often co-occur. As a result, experts have long wondered if one health issue causes the other.

Doctors often diagnose an enlarged uterus in people between 40 and 50 years old. They usually detect endometriosis earlier in life, suggesting it may lead to an enlarged uterus.

Endometriosis inflames the body by making excess estrogen. This estrogen affects the wall of the uterus. Some experts think this inflammation could cause an enlarged uterus.

Common Adenomyosis Symptoms

Both of these diseases have a wide range of symptoms. Some people have many severe symptoms, including pain and period changes. Others will have few symptoms or none at all.

American Family Physician estimates that one in three people with this disease will have no symptoms. For those who do have symptoms, heavy periods are the most common. Many also struggle with pelvic pain and fertility problems.

Common adenomyosis symptoms include:

• Difficulty becoming or staying pregnant.
• An enlarged, bloated belly (due to tumors in an enlarged uterus).
• Heavy periods.
• Pain in the lower belly and pelvic regions.
• Pain when peeing or during bowel movements.
• Pain with penetrative sex.
• Painful periods.
• Uterine tenderness during a pelvic exam.

Common endometriosis symptoms include:

• Bladder symptoms that may get worse during one’s period.
• Bowel symptoms that may get worse during one’s period.
• Heavy periods.
• Pain in the lower belly and pelvic regions.
• Pain when peeing or during bowel movements.
• Pain with penetrative sex.
• Painful periods.

As these lists show, there’s a lot of symptom overlap between these diseases.

How Is Adenomyosis Diagnosed and Treated?

Adenomyosis diagnosis

There’s no simple way to test for adenomyosis. In the past, your doctor found it during surgery. They were often doing surgery for another reason and happened to find an enlarged uterus.

Luckily, there are now better imaging options. Pelvic MRIs and vaginal ultrasounds can detect signs of this disease. Sometimes, a provider may suggest a hysteroscopy to confirm MRI or ultrasound results.

Your doctor will use their imaging results to diagnose an enlarged uterus. This helps you get answers earlier and begin treatment sooner.

Adenomyosis treatment

Medicines

First-line treatment focuses on reducing symptoms. To start, your doctor will suggest hormone-based medicines such as the pill or an IUD.

Hormones thin the lining of the uterus. This can reduce heavy bleeding and period pain.

There are other options for people who don’t respond well to birth control. These include pills that affect the actions of GnRH, another hormone. Providers may also suggest nonsteroidal anti-inflammatory drugs (NSAIDs) to address pain.

Other conservative treatments

Medicines can help with some symptoms. However, other symptoms, like muscle tension, don’t. In these cases, you may need other types of treatment.

Some people find that acupuncture helps reduce their symptoms.

Pelvic physical therapy can help people with endometriosis. Certain hands-on work can reduce muscle tension and tissue sensitivity. Addressing these areas of tension and sensitivity helps improve pain.

Less research exists on the role of physical therapy for adenomyosis. However, the similarities between these diseases suggest that physical therapy could help both.

Surgery

For some people with an enlarged uterus, these treatments don’t work well enough. The next step is often the removal of the uterus.

Like any surgery, a hysterectomy poses certain risks, and it also eliminates your ability to bear children. Most providers view this as the final treatment option.

Surgeons who are experts in minimally invasive gynecologic surgery offer other options. Uterine artery embolization (UAE) cuts off the blood supply to the uterus and the growths inside it. The person can keep their uterus but may find they can’t get pregnant.

Surgery that removes just the lesions that grow in the uterine wall during adenomyosis may help preserve fertility. However, they’re very complex procedures that only some surgeons can do.

Having adenomyosis can feel intense and scary, but you have options. Your provider can help you find the treatments most likely to help with your symptoms.