Adenomyosis: symptoms, causes and treatment options explained

If you have been dealing with painful, heavy periods that seem to get worse every year, you may have heard your gynaecologist mention a condition called adenomyosis. It is a common but often misunderstood uterine condition that affects a significant number of women, especially those in their late thirties and forties. At SRS Speciality Clinic, we frequently meet women who have lived with these symptoms for years before finally getting a diagnosis and the right treatment. This guide explains what adenomyosis is, why it happens, how it is diagnosed, and what your treatment options look like.

What is adenomyosis?

Adenomyosis occurs when the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium) instead of staying where it belongs. Each month, this displaced tissue continues to thicken, break down, and bleed in response to hormonal signals, just as the normal uterine lining does. Because it is now trapped inside the uterine muscle, it has nowhere to go.

Over time, this trapped tissue causes the uterine wall to thicken, and the uterus itself can become enlarged, sometimes growing to two or three times its normal size. That is what leads to the hallmark symptoms of pain and heavy bleeding that many women with adenomyosis experience.

Adenomyosis is different from endometriosis, although the two conditions are related and can occur together. In endometriosis, uterine-lining-like tissue grows outside the uterus, on the ovaries, fallopian tubes, or pelvic lining. In adenomyosis, the tissue stays within the uterine wall itself.

Who gets adenomyosis, and why?

The exact cause of adenomyosis is not fully understood, but researchers believe several factors may contribute, including hormonal influences, genetic predisposition, chronic inflammation, and injury to the uterine wall.

Certain factors appear to raise the risk, including:

• Being between the ages of 40 and 50, though younger women can and do develop adenomyosis
• Having had one or more previous pregnancies and childbirths
• A history of uterine surgery, such as a caesarean section, fibroid removal, or dilation and curettage (D&C)
• A co-existing diagnosis of endometriosis or uterine fibroids

Because adenomyosis is so closely tied to hormonal cycles, symptoms typically improve or resolve entirely after menopause, when oestrogen levels drop significantly.

Common symptoms of adenomyosis

Adenomyosis can present very differently from one woman to another. Around a third of women with the condition have no noticeable symptoms at all, and it may only be discovered incidentally during an ultrasound or pelvic exam for another reason.

When symptoms are present, they often include:

• Heavy or prolonged menstrual bleeding, sometimes with large clots
• Severe menstrual cramps that seem to worsen with age
• Chronic pelvic pain or pressure, not limited to your period
• Pain during sexual intercourse
• Abdominal bloating and a feeling of fullness in the lower abdomen
• Difficulty conceiving, in some cases

Because these symptoms overlap with other gynaecological conditions like fibroids, endometriosis, and hormonal imbalances, adenomyosis is sometimes misdiagnosed or missed entirely for years. If you are experiencing worsening period pain or unusually heavy bleeding, it is important not to dismiss it as “just a bad period.” See also our guide to medical management of heavy bleeding.

How is adenomyosis diagnosed?

There is no single blood test for adenomyosis, so diagnosis usually involves a combination of the following:

• A detailed pelvic examination, during which your gynaecologist in KK Nagar checks for an enlarged, tender, or unusually soft uterus
• A transvaginal ultrasound, which is often the first imaging test used and can show thickening of the uterine wall
• An MRI scan, which offers a more detailed picture of the uterine tissue and can help distinguish adenomyosis from fibroids or other conditions when the diagnosis is not clear on ultrasound alone

In some cases, an endometrial biopsy may be performed, not to confirm adenomyosis directly, but to rule out other causes of abnormal bleeding, such as precancerous changes. The only completely definitive way to confirm adenomyosis is by examining uterine tissue after a hysterectomy, but this is rarely necessary just to reach a diagnosis. Imaging combined with your symptoms is usually sufficient to guide treatment.

Treatment options for adenomyosis

The right treatment depends on your age, symptom severity, whether you want to preserve fertility, and how close you are to menopause. At SRS Speciality Clinic, treatment plans are built around your individual goals rather than a one-size-fits-all approach.

Medical (non-surgical) management

For many women, especially those who wish to avoid surgery or preserve fertility, medical management is the first line of treatment:

• Anti-inflammatory painkillers such as ibuprofen or naproxen, taken a day or two before your period starts and continued through the heaviest days, can reduce both pain and blood loss
• Hormonal birth control, including combined pills, the vaginal ring, or the contraceptive patch, helps regulate the cycle and lighten bleeding
• Progestin-only therapies, such as the hormonal intrauterine device (IUD), often work very well because they thin the uterine lining and can significantly reduce or even stop periods
• Tranexamic acid, a non-hormonal medication taken only during your period, can reduce heavy bleeding without affecting your hormonal cycle
• GnRH agonists or antagonists, used in select cases to temporarily reduce oestrogen levels and shrink the affected tissue, usually as a short-term option or before a planned procedure

Surgical options

When medical management does not provide enough relief, or when symptoms are severe, surgical options may be considered:

• Adenomyomectomy, a uterus-sparing procedure that removes the areas of adenomyosis tissue while preserving the uterus — worth discussing if fertility preservation is a priority
• Hysterectomy, the surgical removal of the uterus, remains the only definitive cure and is typically reserved for women who have completed their families or whose symptoms still affect quality of life despite other treatments

When fertility-sparing surgery is discussed, it may sit alongside laparoscopic surgery in Chennai. Surgical counselling is with Dr. Sharadha SO.

When should you see a gynaecologist?

You do not need to wait until symptoms become unbearable. Consider booking a consultation if your periods are consistently heavier than before, pain disrupts your daily life, bleeding soaks through a pad or tampon every hour for more than two hours, or you are struggling to conceive. If conception is the main goal after treatment, read our IUI fertility guide or the gynaecologist in KK Nagar page.

Living well with adenomyosis

An adenomyosis diagnosis can feel overwhelming, especially after years of being told your symptoms are “normal.” The reassuring news is that with the right combination of medical guidance and, when needed, surgical intervention, most women find significant relief and go on to live full, active lives.

At SRS Speciality Clinic in KK Nagar, Chennai, our women’s health team, led by Dr. Sharadha SO. (MRCOG UK), takes the time to listen to your symptoms, perform a thorough evaluation, and walk you through every treatment option available, so you can make an informed decision about your care.

This article is for informational purposes only and is not a substitute for professional medical advice. Please consult a qualified gynaecologist for diagnosis and treatment tailored to your individual health needs.