In short
Adenomyosis happens when tissue that normally lines the uterus grows into its muscular wall, often causing heavy periods and deep cramping that gets worse with age.
Emergency if: Very heavy bleeding with dizziness, fainting, a racing heart or breathlessness: go to an emergency department now.
On your report
Hemoglobin, Ferritin
On this page
01
What's Actually Happening
Adenomyosis occurs when the tissue that normally lines the inside of the uterus, the endometrium, grows into the muscular wall of the uterus itself. Each month that misplaced tissue still responds to hormonal cycles, thickening and bleeding in place, which enlarges and thickens the uterine wall from within.
It's a distinct condition from endometriosis, where similar tissue grows outside the uterus instead, though the two can occur together. Adenomyosis is most common in people in their 40s who have had children, but it can also appear earlier and sometimes causes no symptoms at all.
02
Recognizing the Symptoms
The most common symptoms are heavy or prolonged menstrual bleeding and progressively worsening menstrual cramps, often described as a deep, dragging pain rather than the sharper cramping of typical periods. Pain during sex and a feeling of pelvic pressure or bloating are also common as the uterus enlarges.
Symptoms tend to build gradually over months or years rather than appearing suddenly, which means many people adjust to worsening periods before recognizing them as something to bring up with a doctor. Bleeding that soaks through a pad or tampon every hour for a few hours, or severe pain that usual pain relievers do not ease, needs a doctor today; if heavy bleeding comes with dizziness, fainting or a racing heart, go to an emergency department now.
03
How It's Diagnosed
Ultrasound is usually the first imaging test, showing a thickened, sometimes irregular uterine wall, though adenomyosis can be subtle enough to miss on a standard scan. MRI gives a clearer picture when ultrasound findings are inconclusive or when planning treatment.
Because heavy bleeding is central to the diagnosis, a clinician will often check a complete blood count for hemoglobin and ferritin for iron stores, since ongoing blood loss can cause iron-deficiency anemia that develops slowly enough to go unnoticed as fatigue rather than obvious bleeding.
04
Managing It
First-line treatment is usually medical: hormonal options such as an intrauterine device, birth control pills, or other hormone therapy that reduce bleeding and calm the abnormal tissue's response to monthly hormone cycles. Anti-inflammatory pain relievers taken around the time of a period can also help with cramping.
When symptoms are severe and medical options haven't helped enough, procedures such as uterine artery embolization can shrink the affected tissue, and hysterectomy remains the only definitive fix since it removes the uterus entirely. The right path depends on symptom severity, age, and whether future pregnancy is a consideration.
05
When to See a Gynecologist
A gynecologist is the right specialist to evaluate worsening periods, pelvic pain, or pressure symptoms, and can distinguish adenomyosis from fibroids, endometriosis, or other causes of similar symptoms through exam and imaging.
Adenomyosis itself isn't dangerous, but the anemia it can cause and its effect on quality of life are real reasons to seek evaluation rather than simply enduring worsening periods. Symptoms often improve after menopause as hormone levels drop.
How urgent is it?
Emergency — act now
Very heavy bleeding with dizziness, fainting, a racing heart or breathlessness: go to an emergency department now.
Same-day — call promptly
Soaking a pad or tampon every hour for a few hours, or period or pelvic pain that is severe or worse than usual and not helped by painkillers: see a doctor today.
Routine — see a doctor
Periods that are getting heavier or more painful, pain during sex, or tiredness that could be anaemia: book a gynaecology appointment.
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Sources
- Adenomyosismedlineplus.gov
- Adenomyosis — NHSnhs.uk
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