Adenomyosis
WRITTEN
BY
Assoc. Prof. Anusch Yazdani
MEDICALLY
REVIEWED BY
Dr Matthew Smith
LAST
REVIEWED
27 July 2026
What is adenomyosis?
Adenomyosis is a condition in which tissue similar to the lining of the uterus (the endometrium) grows into the muscle of the uterus. As this tissue responds to hormonal changes throughout the menstrual cycle, it can cause the uterus to become enlarged, inflamed and painful.
Although adenomyosis and endometriosis can occur together and share many symptoms, they are different conditions. In adenomyosis, the abnormal tissue remains within the wall of the uterus, whereas endometriosis occurs outside the uterus.
The exact cause of adenomyosis remains uncertain. It is likely to result from a combination of factors, including genetic predisposition, hormonal influences, immune system changes, retrograde (reverse) menstrual flow and changes to the cells lining the pelvic cavity.
How common is adenomyosis?
Adenomyosis is more common than many people realise. It affects up to one in five women experiencing pelvic pain or abnormal menstrual bleeding and is particularly common in women who have previously given birth.
Because its symptoms overlap with other gynaecological conditions, such as endometriosis and fibroids, diagnosis can sometimes be delayed.
What does adenomyosis do?
Like the normal lining of the uterus, the endometrial tissue within the uterine muscle responds to the hormonal changes of each menstrual cycle.
This repeated stimulation can cause inflammation, enlargement of the uterus and abnormal uterine contractions, contributing to pain, heavy menstrual bleeding and discomfort. In some women, adenomyosis may also affect fertility.
What are the symptoms?
Symptoms vary considerably and do not always reflect the extent of the disease. Some women with extensive adenomyosis experience few symptoms, while others with relatively mild disease may have significant pain.
Symptoms may include:
- painful periods
- pain during sexual intercourse
- bleeding between periods
- difficulty becoming pregnant (infertility)
- bowel or bladder symptoms that worsen during the menstrual cycle.
How is adenomyosis diagnosed?
Your doctor will begin by discussing your symptoms and medical history before recommending investigations.
Diagnosis is most commonly made by imaging, including:
- specialised pelvic ultrasound
- magnetic resonance imaging (MRI).
Occasionally, adenomyosis is confirmed following examination of uterine tissue after surgery, although this is rarely required to establish the diagnosis.
What are the treatment options?
Treatment depends on the severity of your symptoms, your age, whether you wish to become pregnant in the future and your personal preferences.
Some women with mild symptoms may not require treatment, while others benefit from medication, procedures or surgery.
If you are trying to conceive
For some women, adenomyosis may reduce the likelihood of successful embryo implantation.
If your fertility specialist believes adenomyosis is affecting fertility, treatment with a gonadotrophin-releasing hormone (GnRH) agonist may be recommended before embryo transfer. This treatment temporarily suppresses ovarian hormone production, creating a temporary medical menopause that may improve implantation outcomes.
Medication
Medication can reduce pain and improve heavy menstrual bleeding. Options may include:
- non-steroidal anti-inflammatory medications (NSAIDs)
- progestogens
- the combined oral contraceptive pill
- GnRH analogues.
Your specialist will recommend the most appropriate treatment based on your symptoms and reproductive plans.
Mirena
Mirena, is a hormone-releasing intrauterine device (IUD) that slowly releases progesterone directly into the uterus.
This treatment can significantly reduce heavy menstrual bleeding and period pain while limiting hormone exposure throughout the rest of the body. Many women with adenomyosis experience substantial improvement in their symptoms with a Mirena.
Uterine artery embolisation
Uterine artery embolisation is a minimally invasive procedure performed by an interventional radiologist. By reducing the blood supply to areas affected by adenomyosis, it may improve symptoms in selected women.
Complementary therapies
Some women find complementary therapies helpful alongside medical treatment.
These may include:
- regular exercise
- dietary modification
- yoga
- massage
- Traditional Chinese Medicine (TCM)
- herbal medicine.
Although these therapies do not treat adenomyosis itself, they may improve symptom management and overall wellbeing.
If you choose to use complementary therapies, it is important to consult a qualified practitioner and discuss any treatments with your healthcare team.
Surgery
For women whose symptoms remain severe despite other treatments, surgery may be considered.
In selected cases, surgery can remove areas of adenomyosis while preserving the uterus. However, this is not always possible.
For women who have completed their family and continue to experience significant symptoms, hysterectomy is the only treatment that completely removes adenomyosis.
What can I expect?
The outlook depends on the severity of adenomyosis and the treatment chosen.
Many women achieve excellent symptom control with medication or a Mirena, while others benefit from surgery. With an individualised management plan, it is often possible to significantly improve pain, heavy bleeding and quality of life.
What to remember
Adenomyosis is a common but often under-recognised condition that can affect menstrual bleeding, pelvic pain and fertility.
If heavy periods, painful periods or pain during intercourse are affecting your daily life, it is important to seek medical assessment. An accurate diagnosis allows treatment to be tailored to your individual needs and reproductive goals.
Further Information
For additional evidence-based information and support, visit Endometriosis Australia, which provides information on adenomyosis, endometriosis and chronic pelvic pain.
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
