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Adenomyosis

Endometriosis interna; Adenomyoma; Pelvic pain - adenomyosis

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Adenomyosis is a thickening of the uterus. It occurs when endometrial tissue moves into the outer walls of the uterus. This tissue normally lines the uterus.

Causes

The cause is unknown. Sometimes, adenomyosis may cause a mass or growth within the uterus. This is called an adenomyoma.

The disease most often occurs in women ages 40 to 50 who have had at least one pregnancy.

Symptoms

In many cases, the woman may not have any symptoms. When symptoms occur, they can include:

  • Long-term or heavy menstrual bleeding
  • Painful menstrual periods, which gets worse
  • Pelvic pain during intercourse

Exams and Tests

The health care provider will make the diagnosis if a woman has symptoms of adenomyosis that are not caused by other problems. The only way to confirm the diagnosis is by examining the tissue of the uterus after a surgery to remove it.

During a pelvic exam, the provider may find a soft and slightly enlarged uterus. The exam may also reveal a uterine mass or uterine tenderness.

An ultrasound of the uterus may be done, but it cannot give a clear diagnosis of adenomyosis. MRI can be helpful when other uterine tumors are suspected.

Treatment

Most women have some adenomyosis as they get close to menopause. However, only a few will have symptoms. Most women do not need treatment.

Birth control pills and an IUD that has progesterone can help decrease heavy bleeding. Medicines such as ibuprofen or naproxen can also help manage symptoms.

Surgery to remove the uterus may be done in women with severe symptoms.

Outlook (Prognosis)

Symptoms most often go away after menopause. A hysterectomy completely relieves symptoms.

When to Contact a Medical Professional

Call your provider if you develop symptoms of adenomyosis.

References

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 17.

Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 18.

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        Review Date: 5/16/2016

        Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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