Adenomyosis
What is Adenomyosis? Adenomyosis is when the lining of the uterus (the endometrium) grows in the muscle of the uterus (myometrium). What are the symptoms of Adenomyosis? It is possible to not experience symptoms with adenomyosis, and symptoms usually go away after menopause. However, some women experience: Pelvic pain Periods issues Painful sex Painful when going to the toilet
What it is
The deposits inside the myometrium cause the uterine wall to thicken, become tender and bleed into itself during menstruation. The classical patient is a woman in her late 30s or 40s with a long history of progressively worse periods. Diagnosis is now reliably made on high-quality transvaginal ultrasound or MRI without needing surgery.
Symptoms and signs
- Severe, cramping period pain that has become worse over years.
- Heavy menstrual bleeding (menorrhagia) — flooding, clots, soaking through protection.
- A sensation of pelvic pressure or bulkiness — the uterus is typically enlarged and tender on examination.
- Painful intercourse and chronic low-grade pelvic discomfort.
- Often coexists with fibroids and endometriosis — and is often missed when those are diagnosed.
How we investigate
Detailed history with menstrual diary, pelvic examination and a high-resolution transvaginal pelvic ultrasound performed by a gynaecologist (not a generalist sonographer) using specific MUSA criteria. Pelvic MRI where the ultrasound is inconclusive or surgical planning is needed.
Treatment options at The Vesey
- Mirena IUS — first-line for symptom control in most patients, fitted on-site by our consultants. Two-thirds of patients see meaningful improvement within 6 months.
- Tranexamic acid and NSAIDs — for acute heavy-bleeding cycles while longer-term strategy is established.
- GnRH analogues with add-back HRT — short-term symptom control and a useful predictor of likely response to definitive surgery.
- Endometrial ablation — for selected cases where bleeding (rather than pain) is the dominant problem and family is complete.
- Hysterectomy — definitive treatment for women who have completed their family and have severe symptoms unresponsive to medical management.
Frequently asked questions
Can adenomyosis cause infertility?
Adenomyosis can reduce fertility and is associated with a higher risk of miscarriage and preterm birth. However, many women with adenomyosis conceive naturally. Fertility-sparing treatment options are central to the consultation for women who wish to conceive.
What is the difference between adenomyosis and endometriosis?
Endometriosis is where uterine-lining tissue grows outside the uterus (on ovaries, tubes or bowel). Adenomyosis is where it grows inside the muscle wall of the uterus. They frequently coexist and share similar symptoms but have different treatment pathways.
Is adenomyosis diagnosed by ultrasound?
Yes. High-quality transvaginal ultrasound using MUSA criteria is the first-line diagnostic tool and is accurate in experienced hands. Pelvic MRI is used when ultrasound findings are equivocal or when surgical planning is required.
Does adenomyosis go away after menopause?
In most cases, yes — adenomyosis is oestrogen-dependent so symptoms typically resolve after the menopause when oestrogen levels fall. GnRH analogues (which induce a temporary menopause-like state) can be effective as a short-term treatment.
Private consultation at The Vesey
From £90 (Private GP) · Specialist from £260 · No GP referral required · Open 7 days 8am–8pm
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When to see a specialist
See us if you have had progressively worse periods for more than 12 months and have either been told "everything is normal" without a focused adenomyosis assessment, or are weighing up whether to pursue hysterectomy and want a second opinion on alternatives.
Cost and pathway
Initial consultant gynaecology consultation £260. High-resolution transvaginal pelvic ultrasound interpreted by your consultant from £290. Mirena IUS fitting from £350 including device. Surgical pricing on written quotation.
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