Overview

Adenomyosis occurs when the endometrium grows into the myometrium (uterine muscle wall). Each month this misplaced tissue thickens and bleeds, causing the uterus to enlarge and become tender. It affects up to 20–35% of reproductive-age women and coexists with endometriosis in up to 65% of cases.

Symptoms

• Heavy menstrual bleeding — often causing anaemia
• Severe, cramping period pain — often worsening over time
• Pressure or heaviness in the lower abdomen
• Enlarged, "boggy" uterus on examination
• Pain during intercourse
• Difficulty conceiving or recurrent implantation failure in IVF
• Some women have no symptoms

Causes & Risk Factors

• Uterine trauma — caesarean section, curettage, instrumentation
• Oestrogen promotes growth; regresses after menopause
• Co-existing endometriosis or fibroids
• Age 40–50 — though increasingly recognised in younger women

Diagnosis

• Transvaginal ultrasound — heterogeneous uterus, myometrial cysts, thickened junctional zone
• MRI — most accurate; junctional zone >12mm is diagnostic

Treatment

• Hormonal IUD (Mirena) — highly effective for bleeding and pain
• Combined oral contraceptives
• GnRH agonists/antagonists — temporary medical menopause; used before IVF or surgery
• NSAIDs for pain management
• Hysterectomy — definitive cure for those who have completed their family
• IVF with GnRH agonist pre-treatment — improves pregnancy rates in adenomyosis

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