Adenomyosis
The overlooked twin of endometriosis.
Often not considered or missed, adenomyosis causes heavy bleeding, pain, and fertility challenges. Here’s how we diagnose and treat it.
A Common Yet Neglected Disease
Understanding Adenomyosis
Adenomyosis affects millions of women worldwide, but often goes undiagnosed or unrecognized, despite its significant impact on quality of life. For many, it can be a hidden source of pelvic pain, heavy bleeding, and fertility struggles that are too often dismissed. Gaining clarity about adenomyosis is essential for accurate diagnosis and for creating treatment plans that truly address the root of a patient’s symptoms.
What is it?
Adenomyosis is a condition where endometrial-like tissue grows into the muscular wall of the uterus (the myometrium). This can lead to an enlarged uterus, painful periods, heavy bleeding, and fertility challenges.
When can it happen?
Adenomyosis is thought to impact between 20% and 35% of women of reproductive age. However, the true prevalence of the condition may be underestimated due to the invasive nature of diagnostic procedures and non-specific symptoms.
Why does it occur?
The exact cause of adenomyosis is not fully understood, but genetic, hormonal, and immune factors are thought to play a role. Ongoing research suggests it is likely a multifactorial condition influenced by several overlapping biological processes.
Where can it spread?
Unlike endometriosis, adenomyosis does not spread outside the uterus. It remains within the muscular wall of the uterus itself, though it can be diffuse or form localized growths called adenomyomas.
Comparing the Conditions
Similarities to Endometriosis
Endometriosis and adenomyosis share a defining feature: tissue resembling the uterine lining that grows where it shouldn’t, yet still responds to hormonal cycles. In endometriosis, this tissue implants outside the uterus; in adenomyosis, it burrows into the uterine muscle itself. In both cases, the tissue swells and bleeds with each cycle, but because it has no normal way to exit the body, it sets off chronic inflammation, scarring, and pain. These changes can ripple outward, affecting fertility, sexual health, and day-to-day function. While most common in women of reproductive age, both conditions may also persist beyond menopause, underscoring how complex and long-lasting their impact can be. Though their root causes are still under study, evidence suggests overlapping genetic, hormonal, and immune pathways that make them deeply interconnected yet uniquely challenging to diagnose and manage.
Comparison Continued
Differences
Although endometriosis and adenomyosis share certain features, they differ in ways that have important implications for diagnosis, treatment, and patient care. These distinctions affect where and how the conditions develop, how often they occur, and what tools doctors use to identify and manage them. Understanding these differences helps patients and providers choose the most effective strategies for relief and long-term health.
Anatomical Location
The key distinction lies in where the endometrial-like tissue is found. In endometriosis, it grows outside the uterus—commonly on the ovaries, fallopian tubes, peritoneum, and sometimes even beyond the pelvis. Adenomyosis, on the other hand, occurs when this tissue penetrates into the uterine muscle wall (myometrium), causing the uterus itself to enlarge and become more tender.
Prevalence
Endometriosis is estimated to affect about 1 in 10 women of reproductive age, while adenomyosis is thought to impact closer to 1 in 3. Both figures are likely underestimates, as many cases go unrecognized due to vague symptoms and the challenges of making a definitive diagnosis without invasive procedures. This means the real burden of disease may be much greater than currently reported.
Diagnosis
Confirming each condition requires different approaches. For endometriosis, minimally invasive surgery such as laparoscopy or robotics remains the gold standard, as it allows direct visualization and removal of lesions when needed. Adenomyosis is more often suspected through imaging like ultrasound or MRI, but can usually only be definitively confirmed when the uterus is surgically removed and examined under a microscope. In select cases, discrete adenomyomas can be removed while leaving the uterus intact, though this is not always possible when the disease is widespread.
Treatment
Management for both conditions may include hormonal therapies—such as oral contraceptives, progestins, or GnRH agents—along with integrative strategies like nutrition and lifestyle changes to reduce inflammation and balance hormones. However, surgical choices diverge significantly. Endometriosis is typically treated with laparoscopic or robotic excision of ectopic tissue, preserving fertility whenever possible. In severe adenomyosis, hysterectomy may be considered if childbearing is no longer desired, though in some cases targeted removal of adenomyomas allows the uterus to be preserved. Each decision is highly individualized, balancing symptom control, reproductive goals, and overall health.
Why these Differences Matter
Knowing the differences between endometriosis and adenomyosis is only the first step—what matters most is how these insights are applied to your personal care. Our comprehensive evaluation and diagnosis process is designed to uncover the true source of your pain and guide you toward the right treatment path.
When Endo and Adeno Overlap
Condition Associations
Endometriosis and adenomyosis often overlap, with research showing that adenomyosis is more common in women who already have endometriosis. When the two conditions coexist, symptoms can intensify, making diagnosis and management more complex.
Chronic Pelvic Pain
Persistent pain is common in both disorders and can significantly affect daily life and functioning.
Uterine fibroids
Adenomyosis may occur alongside fibroids (leiomyomas), adding to the challenges of accurate diagnosis and effective treatment.
Autoimmune and Inflammatory Diseases
Endometriosis is associated with a higher risk of autoimmune conditions such as rheumatoid arthritis, lupus, and inflammatory bowel disease, and early evidence suggests adenomyosis may share some of these links.
Mental Health
Living with chronic pain and fertility challenges contributes to higher rates of depression, anxiety, and reduced quality of life in patients with either condition. This is why it is our mission to help as many patients as possible.
Looking Ahead
Research & Future Directions
Research into endometriosis and adenomyosis continues to expand, offering hope for earlier diagnosis, better treatments, and deeper understanding of how these conditions develop. Key areas of focus include:
Biomarkers
Scientists are working to identify reliable biomarkers that could detect endometriosis and adenomyosis through blood or other non-invasive samples, allowing for earlier diagnosis and intervention.
Non-Invasive Imaging
Advances in ultrasound and MRI technology aim to improve accuracy in detecting these conditions without the need for invasive procedures, making diagnosis easier and safer.
New Therapies
Targeted hormonal treatments, immunomodulators, and anti-inflammatory agents are being studied as potential ways to relieve symptoms, preserve fertility, and address disease progression.
Genetic & Epigenetic Insights
Ongoing research is exploring the genetic and epigenetic mechanisms behind these conditions, with the goal of uncovering their root causes and guiding the development of more precise therapies.
Reach Out
Have a question?
We understand that healthcare can be complex and overwhelming, and we are committed to making the process as easy and stress-free as possible.
Call Us
(424) 255-1340
Santa Monica, CA
2121 Santa Monica Blvd, Santa Monica, CA 90404
Operating Hours
9:00 am - 5:00 pm
Monday - Friday
Arroyo Grande, CA
154 Traffic Way, Arroyo Grande, CA 93420