Adenomyosis occurs when tissue similar to the uterine lining is present within the muscle of the uterus. It may cause heavy bleeding, painful periods, pelvic pressure or no symptoms, and it can coexist with fibroids or endometriosis.

Symptoms overlap with other causes of heavy bleeding and pelvic pain, so assessment should be broad.

Ultrasound is usually the first imaging test; MRI may help when the diagnosis or treatment plan is uncertain.

Treatment depends on bleeding, pain, age, fertility goals and whether uterine preservation is important.

Original educational diagram for Adenomyosis — Original educational diagram created for this topic. It explains the care pathway visually and is not a diagnostic image.

Symptoms and differential diagnosis

Heavy or prolonged periods, severe cramping, pelvic pressure and pain during sex may occur. Clinicians also assess for fibroids, endometriosis, bleeding disorders, thyroid disease and endometrial pathology.

Imaging and diagnostic confidence

Transvaginal ultrasound can identify features suggestive of adenomyosis. MRI can add detail in selected cases. No imaging test is perfect, so findings must be interpreted with symptoms and examination.

Medical treatment

Options may include anti-inflammatory pain relief, medicines that reduce bleeding, hormonal contraception, progestogen therapy or a hormone-releasing intrauterine system when suitable. Response and side effects should be reviewed rather than treatment continuing indefinitely without reassessment.

Procedural and surgical choices

Uterine-sparing procedures may be considered in selected settings, but evidence and fertility implications vary. Hysterectomy is definitive for uterine adenomyosis when symptoms are severe and future pregnancy is not desired. Decisions should include recovery time and alternatives.

Questions worth discussing at your consultation

Do the scan findings explain my symptoms?
Could fibroids or endometriosis also be present?
Which options preserve fertility or the uterus?
How will we judge whether treatment is working?

When to seek urgent careSeek urgent care for soaking pads rapidly, fainting, severe sudden pelvic pain, fever, a positive pregnancy test with pain or bleeding, or symptoms of significant anaemia.

Medical note: This page is educational and is structured to support a specialist consultation. Diagnosis, investigations and treatment must be individualised. It has not been presented as a substitute for an examination or emergency assessment.