About Adenomyosis

Adenomyosis is often referred to in the EndometriosisWA support group as endometriosis’s “evil cousin”. Previously considered to be a condition affecting patients older than 40, often after having been pregnant, it is increasingly being identified in young, nulliparous (never been pregnant) patients^1,2,3.

Like endometriosis, symptoms can include pelvic pain, and heavy painful periods. The condition is caused by endometrial tissue growing within the muscular wall, or myometrium, of the uterus. Unlike endometriosis, this tissue is thought to be identical to normal endometrium. Estimates of prevalence vary widely from 1% to 80%, due to the lack of consistent criteria for diagnosis. More recent studies have found rates of around 30% in people who have suggestive symptoms.

The cause is still unknown. Theories include endometrium being forced into the uterine wall due to damage or trauma, or inappropriate transformation of stem cells (Müllerian metaplasia). What we do know that the disease can be diffuse (spread across a large area) or focal, potentially forming a tumour-like mass called an adenomyoma. Like endometriosis, specialised imaging including ultrasound and MRI can be suggestive of the disease, but the diagnosis is confirmed with examination of the uterus by a pathologist after hysterectomy or removal of an adenomyoma.

Treatment options are similar to endometriosis and include pain relief and suppression of menstruation. Creating an artificial blood clot to reduce blood supply to the uterus, known as uterine artery embolization, can also be considered. Hysterectomy is considered to be the cure.

Exacoustos C, Lazzeri L, Martire F, Russo C, Martone S, Centini G, et al. Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease. The Journal of Minimally Invasive Gynaecology. 2022;29(2):291-299.
Schräger S, Yogendran L, Marquez CM & Sadowski EA. Adenomyosis: Diagnosis and Management. American Family Physician. 2022;105(1):33-38.
Zanolli NC, Cline BC, Befera NT & Martin JG. Diagnostic accuracy of clinically reported adenomyosis on pelvic ultrasound and MRI compared to surgical pathology. Clinical Imaging. 2021;82:117-120.