Adenomyosis (of the Uterus)

Adenomyosis causes heavy, painful menstrual periods.

Uterine adenomyosis is a condition in which the inner lining of the uterus grows into the muscle wall of the uterus (myometrium) causing heavy, painful menstrual periods.

Adenomyosis is often seen with other uterine problems such as endometriosis. Endometriosis is a condition in which endometrial cells (the lining of the uterus) grow outside of the uterus. Both adenomyosis and endometriosis cause pain, but endometriosis does not usually result in heavy menstrual periods.

The cause of adenomyosis is unknown but some causes may include:

• Hormones
• Bone marrow stem cells entering the uterine muscle
• Inflammation of the uterus following childbirth
• Risk factors for adenomyosis include:
• Childbirth
• Early age of menstrual onset
• Short menstrual cycles
• Previous uterine surgeries
• Cesarean section
• Removal of uterine fibroids (myomectomy)
• Middle age

Signs and symptoms of adenomyosis include:

• Heavy periods
• Prolonged menstrual bleeding
• Painful periods/menstrual cramping (may be severe)
• Chronic pelvic pain
• Lower abdominal pain or tenderness
• Pain in the back and legs
• Pelvic pressure
• Abdominal bloating/swelling
• Blood clots in the pelvis and legs
• Painful intercourse
• Complications of adenomyosis include:
• Anemia from heavy bleeding
• Decreased quality of life from pain and heavy bleeding

Along with a medical history and pelvic examination, doctors begin to diagnose adenomyosis through imaging studies such as ultrasound. However, the only true diagnosis of adenomyosis can be made based on pathology of the uterus which is evaluated after a hysterectomy (removal of the uterus).

A pelvic exam of a woman with adenomyosis may find an enlarged and soft uterus. The uterus may also be mobile, meaning it moves around and is not fixed in place. 

Imaging tests for diagnosis may include:

• Transvaginal ultrasound
• Magnetic resonance imaging (MRI)

Blood tests may also be ordered to rule out pregnancy, check for anemia, or exclude other conditions.

In some cases, an endometrial biopsy, in which a small piece of tissue from the lining of the uterus is removed and sent to a lab for examination, is performed. It is usually performed to rule out endometrial hyperplasia (thickening of the lining of the uterus) or cancer.

The only cure for adenomyosis is surgical removal of the uterus, called a hysterectomy.

Treatment options that may reduce heavy bleeding include:

• Intrauterine devices (IUDs), specifically one that releases the hormone progestin
• Endometrial ablation is a surgery to scar the lining of the uterus, which makes periods lighter
• Uterine artery embolization blocks the blood supply to the uterus
• Treatments options for adenomyosis pain include:
• Birth control pills
• Over-the-counter pain medications, such as ibuprofen (Advil, Motrin)
• Leuprolide (Lupron, Eligard), a prescription medicine that causes the ovaries to stop producing estrogen and progesterone

The Adenomyosis Advice Association’s recommended diet if you have adenomyosis includes eating:

• Fruits
• Vegetables
• Beans and legumes
• Whole grains 
• Nuts
• Certain herbs:
  • garlic,
  • basil,
  • cinnamon,
  • caraway,
  • dill,
  • ginger,
  • parsley,
  • peppermint,
  • rosemary,
  • sage, and 
  • thyme
• Eggs
• Fresh fish
• Cold-pressed olive oil
• Coconut or almond milk (avoid soy milk)
• Honey and molasses
• Fruit teas

Foods to limit on an adenomyosis diet include:

• Meat (eat only organic if you do eat meat)
• Salt

Foods to avoid on an adenomyosis diet include:

• Wheat and gluten
• Artificial sugars
• Dairy
• Bananas
• Yeast-based products including alcohol, tea, and coffee
• Chasteberry (Vitex agnus-castus) and red raspberry leaf/raspberry teas

A hysterectomy to remove the uterus will cure adenomyosis, and women will have no further symptoms.

Women with adenomyosis may be at higher risk of developing endometrial and thyroid cancers.

In women who do not have a hysterectomy, it is not clear whether adenomyosis affects fertility. Some studies show it decreases fertility and other studies show it has no effect on getting pregnant. It is believed the severe inflammation caused by adenomyosis may inhibit implantation of an embryo into the uterine lining, preventing pregnancy from occurring.