We have written before about endometriosis — a condition where cells like those lining the womb grow outside it. Adenomyosis is its lesser-known relative. The inner lining of the womb is called the endometrium, and the muscular wall around it the myometrium. When endometrium-like cells grow within the muscle wall itself, the condition is called adenomyosis.

Two reassurances first. Adenomyosis is not a tumour and not a cancer — it is a benign condition. And if it is found on a scan but causes you no symptoms, it does not normally need any treatment at all.

Who gets adenomyosis?

Adenomyosis is most often diagnosed in women who have had children, but it can affect younger women too — including those who have never been pregnant. For many years it was believed to be a condition of older women, mainly because it could only be confirmed after hysterectomy. Modern scanning has changed that: adenomyosis is now increasingly recognised in younger women without any operation.

Sometimes the condition is confined to one area of the womb, forming a lump called an adenomyoma; more commonly it is spread diffusely through the muscle wall, which may make the womb enlarged, thickened and tender.

What are the symptoms?

  • Heavy bleeding during periods — sometimes with clots, flooding, or anaemia
  • Severe period pain that may worsen over the years
  • Pain or discomfort in the lower abdomen and pelvis, sometimes with a feeling of pressure or bloating
  • Pain during sex
  • Difficulty conceiving in some women

Some women with adenomyosis have no symptoms at all. But if heavy or painful periods are affecting your life, do not accept them as "normal" — see a gynaecologist and get examined.

How is it diagnosed?

The first and most useful test is a transvaginal ultrasound scan — a scan performed with a slim probe placed in the vagina, which shows the womb's muscle wall in detail. A good-quality scan in experienced hands can identify the typical features of adenomyosis; where the picture remains unclear, an MRI scan is a useful second test. Where a transvaginal scan is not suitable, an abdominal scan or MRI can be used instead.

Because heavy bleeding gradually drains the body's iron stores, your doctor will usually also check a blood count for anaemia and treat it with iron if needed.

Medical treatment — the first step

Treatment depends on your symptoms, your age and whether you are hoping for children. It should always be individualised — there is no single drug that suits everyone. Options include:

  • The hormonal coil (LNG-IUS) — a small device placed inside the womb that releases a progestogen hormone. It is recommended as a first-line treatment for heavy bleeding associated with adenomyosis, and in many women it dramatically reduces both bleeding and pain.
  • Tranexamic acid — non-hormonal tablets taken only during periods to reduce bleeding.
  • Anti-inflammatory painkillers (NSAIDs) such as mefenamic acid, which ease pain and modestly reduce bleeding.
  • Hormonal treatments — the combined pill or progestogens, which can make periods lighter and less painful.

These treatments control symptoms very well for many women, but they do not remove the adenomyosis itself. If they are not enough, it is time to discuss the next step with a specialist.

Surgery and other procedures

Adenomyomectomy — removing only the diseased part. When adenomyosis is confined to one area as an adenomyoma, it is sometimes possible to remove only the affected portion and preserve the womb. For a woman hoping for children, this operation can be performed laparoscopically (keyhole surgery), with minimal damage to the womb and surrounding tissues.

Hysterectomy — the definitive cure. When adenomyosis is spread throughout the womb's walls and symptoms are severe, removing the womb is the one permanent solution. The ovaries do not need to be removed, so hormones and general health are unaffected. The operation can now be done laparoscopically as a total laparoscopic hysterectomy (TLH) — small cuts, less pain, and a much faster recovery. Our step-by-step surgery guide explains what to expect.

Adenomyosis and fertility

Adenomyosis is associated with reduced fertility and with somewhat higher risks in pregnancy, including miscarriage and preterm birth. That is a reason for assessment and planning — not for despair: many women with adenomyosis conceive and deliver healthy babies. If you have adenomyosis and are finding it difficult to conceive, discuss it with your gynaecologist early so treatment can be tailored around your fertility plans.

The bottom line

  • Adenomyosis is a benign condition in which womb-lining cells grow inside the womb's muscle wall.
  • Typical symptoms are heavy, painful periods, pelvic pain and pain during sex — but some women have none.
  • A transvaginal scan is usually all that is needed for diagnosis; MRI helps in unclear cases.
  • The hormonal coil is the usual first treatment; tablets can also control bleeding and pain.
  • Keyhole surgery — from adenomyomectomy to laparoscopic hysterectomy — offers a lasting solution when medicines are not enough.

If heavy or painful periods are disrupting your life, you can consult us at Sugabi Clinic Ragama. See also our guides to menstrual problems and endometriosis.

References

  1. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management (NG88) [Internet]. London: NICE; 2018 [updated 2026 Jul 7; cited 2026 Aug 9]. Available from: nice.org.uk/guidance/ng88
  2. NHS. Adenomyosis [Internet]. London: NHS; [cited 2026 Aug 9]. Available from: nhs.uk
  3. University College London Hospitals NHS Foundation Trust. Understanding adenomyosis [Internet]. London: UCLH; [updated 2026 Jun 30; cited 2026 Aug 9]. Available from: uclh.nhs.uk
  4. Dixon S, Topbas Selcuki NF, Round T, Hayward G, Vincent K. Uterine adenomyosis: an update for GPs. Br J Gen Pract. 2023;73(736):524–5. doi:10.3399/bjgp23X735549
  5. Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, et al. Guideline No. 437: diagnosis and management of adenomyosis. J Obstet Gynaecol Can. 2023;45(6):417–429.e1. doi:10.1016/j.jogc.2023.04.008
  6. Harada T, Taniguchi F, Guo SW, Choi YM, Biberoglu KO, Tsai SJS, et al. The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis. Reprod Med Biol. 2023;22(1):e12535. doi:10.1002/rmb2.12535
  7. Tellum T, Nygaard S, Lieng M. Noninvasive diagnosis of adenomyosis: a structured review and meta-analysis of diagnostic accuracy in imaging. J Minim Invasive Gynecol. 2020;27(2):408–418.e3. doi:10.1016/j.jmig.2019.11.001
  8. Galati G, Ruggiero G, Grobberio A, Capri O, Pietrangeli D, Recine N, et al. The role of different medical therapies in the management of adenomyosis: a systematic review and meta-analysis. J Clin Med. 2024;13(11):3302. doi:10.3390/jcm13113302
  9. Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206. doi:10.1016/j.rbmo.2020.09.023