Adenomyosis

Heavy periods and pain can be part of adenomyosis, a condition in which the lining of the womb grows into its muscle wall. Some people have no symptoms. Others have pain severe enough to interrupt everyday activities. Treatment depends on how the condition affects you.

Where adenomyosis happens

The womb, also called the uterus, has an inner lining and an outer muscle layer. Adenomyosis affects that muscle layer. Endometriosis is a different condition, involving tissue similar to the womb lining outside the womb, for example around the ovaries. The similar names describe conditions in different locations.

The cause of adenomyosis is not known. It is a benign condition, meaning it is not considered precancerous. Symptoms can include heavy or painful periods, pelvic pain between periods, a feeling of fullness or bloating, and pain during sex. A clinician can look into these symptoms and check for other causes.

What an appointment and scan involve

A GP may ask about your periods, feel your abdomen and discuss an internal examination. You can ask to have a friend, family member or another member of staff in the room. Say what you are comfortable with before an examination begins, and ask the clinician to explain what they are checking.

Ultrasound is usually the first scan used to assess adenomyosis. A vaginal ultrasound and an MRI can both help identify it. MRI may be useful when an ultrasound has not provided enough information. The scan is part of the assessment. Ask the clinician how the findings fit with your symptoms.

You may read that adenomyosis can only be confirmed after a hysterectomy. MedlinePlus draws a distinction between confirming adenomyosis by examining removed womb tissue and assessing it through symptoms and scans. UCLH describes ultrasound and MRI as ways to diagnose it. This guidance does not say you routinely need surgery to collect tissue before you can receive care.

Options for bleeding and pain

If a scan suggests adenomyosis but you have no symptoms, treatment may not be needed. If symptoms are troubling you, options include anti-inflammatory pain relief and tranexamic acid for heavy bleeding. Your pharmacist, GP or doctor can advise about suitability; follow the leaflet and any prescription instructions.

Hormonal treatment is another option. A hormonal coil, called an IUS in UK guidance, can make periods lighter and less painful. You can discuss other hormonal contraceptives if a coil does not suit you or you do not want one. A heat pad or a hot water bottle wrapped in a tea towel may help with pain alongside your treatment plan.

When specialist treatment is considered

If initial treatments do not help, discuss specialist options. A hysterectomy removes the womb and can resolve adenomyosis, but it is major surgery and means you cannot carry a future pregnancy. UCLH describes it as a last resort. Say if keeping your womb matters to you, including if you are unsure about pregnancy.

Symptoms often settle after menopause. That can be part of a treatment discussion, alongside your preferences and how well previous treatments have worked. Ask what the treatment aims to improve and what its risks are. You can also ask about alternatives if you decide against it.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for any vaginal bleeding after menopause, even a small amount or a single episode. Do not assume it is caused by adenomyosis.

Getting help for pain or changing bleeding

Call 999 now (UK) or 911 (US), or your local emergency number, if pelvic pain comes with faintness, difficulty breathing or heavy vaginal bleeding, or is severe or getting worse. Also call for heavy vaginal bleeding with faintness, collapse or difficulty breathing, even without pelvic pain.

Get help today from NHS 111 or an urgent GP service (UK), or your doctor or urgent care service (US or elsewhere), if period pain is worse than usual and painkillers have not helped; if you have pelvic pain and are pregnant or could be pregnant; or if pelvic pain comes with a very high temperature or feeling hot, cold or shivery. Use emergency care for the symptoms above.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for heavier or more painful periods, pain during sex, or bleeding between periods or after sex.