What is adenomyosis?

Adenomyosis is a condition in which tissue similar to the lining of the uterus (endometrium) grows into the muscular wall of the uterus (myometrium). As a result, the uterine wall thickens and its structure is disrupted.

This tissue responds to hormonal changes during the menstrual cycle similarly to the endometrium in the uterine cavity — it grows, thickens, and triggers an inflammatory reaction. This can lead to heavy bleeding and chronic pain. However, approximately one-third of women with adenomyosis do not experience any significant symptoms.

What is endometriosis?

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus is found outside the uterine cavity. Most commonly, it occurs on the ovaries, peritoneum, intestines, or bladder, but it can also affect more distant organs.

Endometriotic lesions respond to hormonal changes during the cycle, leading to recurrent inflammatory processes, adhesion formation, and pain. Worldwide, approximately 1 in 10 women of reproductive age suffer from endometriosis.

Key difference: adenomyosis grows into the uterine wall — endometriosis grows outside of it.

Causes of both conditions

Adenomyosis

The exact mechanism of adenomyosis development is not fully understood. One of the main theories suggests a disruption of the uterine lining surface — for example, in connection with childbirth, uterine surgery, or long-term hormonal influences. Stem cells or inflammatory processes may also play a role.

Endometriosis

Even for endometriosis, the cause is not clear. A multifactorial origin is considered, involving genetic predispositions, immune system disorders, hormonal influences, and chronic inflammation.

The most frequently mentioned theory is so-called retrograde menstruation — menstrual blood containing endometrial cells flows backward into the abdominal cavity, where the cells implant and grow. However, this theory does not explain all cases: up to 70–90% of women have some degree of retrograde menstruation, but not all of them develop endometriosis.

Symptoms and how they differ

The symptoms of both adenomyosis and endometriosis can overlap, and their intensity varies significantly among individual women. Here are the common signs and what differentiates them:

Symptoms common to both conditions: chronic pelvic pain, painful menstruation, painful intercourse, and difficulty conceiving.

Diagnosis

The diagnostic process for both conditions begins with a detailed interview with a doctor and a gynecological examination. A description of symptoms, their intensity, and timing during the cycle is important.

Adenomyosis

Thanks to advances in imaging methods, adenomyosis can now be diagnosed non-invasively — high-quality ultrasound or MRI can show typical changes in the uterine wall and allow diagnosis without surgery.

Endometriosis

Ultrasound and MRI can reveal more advanced forms of the disease, such as ovarian cysts or deep infiltrating endometriosis. However, smaller lesions are often not visible. A definitive diagnosis is therefore most often confirmed by laparoscopy — a minimally invasive surgical procedure that also allows for the removal of lesions.

Research is currently underway on new, less invasive diagnostic methods — for example, using saliva or menstrual blood.

Tip: If you are seeing a gynecologist for the first time with suspected endometriosis or adenomyosis, prepare a list of symptoms — when they appear, how intense they are, and whether they are related to a specific phase of the cycle. The more specific information you bring, the faster the diagnostic process can be.

Treatment

Treatment for both conditions is individual and depends on the severity of symptoms, the patient's age, and her reproductive plans. In general, the earlier the condition is detected, the more options are available.

Common approaches

• Analgesics for pain relief
• Hormonal therapy to regulate the cycle and reduce inflammation
• Physiotherapy focused on the pelvic floor
• Lifestyle adjustments — diet, exercise, stress management
• Supportive methods: heat, dietary supplements

Adenomyosis — specific options

Hormonal therapy (birth control pills or an IUD releasing progesterone) can help regulate the menstrual cycle and alleviate symptoms. In severe cases, surgical treatment may be considered. A definitive solution is a hysterectomy — removal of the uterus — which, however, means a loss of reproductive capacity.

Endometriosis — specific options

A combination of hormonal therapy and surgical removal of lesions (laparoscopy) is the most common approach. Hysterectomy is considered if the patient does not respond to other treatment methods and does not plan to conceive — however, even this procedure may not lead to the complete disappearance of symptoms.

Can you have adenomyosis and endometriosis at the same time?

Yes. Although these are distinct conditions, they can occur simultaneously. A 2017 study tracking 300 women diagnosed with adenomyosis found that in 42.3% of cases, endometriosis was also present. However, the results of various studies differ, and the exact rate of co-occurrence cannot be determined with certainty.

If treatment for one condition does not yield expected results, it is worth considering testing for the presence of the other.

What to do if you suspect you have it

Symptoms of both adenomyosis and endometriosis are often underestimated or considered a "normal" part of menstruation. Severe or recurring pain, heavy bleeding, and fatigue that interferes with daily life are not normal — and it is important to address them.

1. Track your menstrual cycle. Record the intensity of pain, bleeding, and other symptoms in relation to the phase of your cycle. A symptom diary is valuable information for your gynecologist.
2. Prepare a list of symptoms. When they appear, how severe they are, what makes them worse or better.
3. Talk to your gynecologist. Ask for an examination — an ultrasound as a first step is accessible and non-invasive.
4. Don't be alone. A community of women going through a similar journey can be an important part of the process — emotionally and practically.