Adenomyosis: endo’s lesser-known cousin

In adenomyosis, the womb lining grows into the muscular wall of the womb. That tissue still responds to your cycle, which can make periods very painful and heavy. It is less talked about than endometriosis, but it is not rare. Endometriosis UK says it affects about 1 in 10 people assigned female at birth, and it is common to have both.

Signs

• Severe period pain that can stop you doing usual activities
• Heavy bleeding
• Pelvic pain, bloating or a feeling of fullness in your tummy
• Pain during or after sex
• Some people have no symptoms at all

The NHS says symptoms usually affect people over 35, but anyone who has periods can get it. You may be more likely to get it if you have given birth or have endometriosis. Adenomyosis can make it harder to get pregnant and can raise the chance of miscarriage, so talk to a doctor if that matters to you.

Why diagnosis can be slow

Symptoms overlap with endometriosis, fibroids, polyps and a thickened womb lining. A GP may examine you and arrange an ultrasound or MRI to look at the womb wall. NICE says that for heavy bleeding with significant period pain, a transvaginal ultrasound is the preferred first scan for suspected adenomyosis.

Treatment

• The hormonal coil (IUS), which thins the lining and lightens periods. NICE says to consider it as the first treatment for heavy bleeding in suspected or diagnosed adenomyosis.
• Other hormonal options, such as the progestogen-only pill, combined pill or patch
• NSAIDs for pain or tranexamic acid for heavy bleeding
• Heat pads and TENS machines for self-care
• If those do not work: a procedure to block the blood supply (uterine artery embolisation), or a hysterectomy, which is the only way to cure adenomyosis but means you cannot carry a pregnancy