A woman in a hijab resting on a sofa at home with a hot water bottle on her lower tummy and a cup of tea

Adenomyosis: Maksud, Simptom & Rawatan

Adenomyosis is where the lining of the womb grows into the muscle of the womb wall. It can cause heavy, painful periods, pelvic pain and bloating, although about 1 in 3 people have no symptoms. It is not cancer, and treatments such as the hormonal coil can ease symptoms. This guide explains the adenomyosis maksud, the symptoms, how it differs from endometriosis and fibroids, what an adenomyosis ultrasound can show, rawatan (treatment) options, and what it means for getting pregnant.

Apa itu adenomyosis (adenomyosis maksud)?

According to the NHS, adenomyosis is where the lining of the womb (uterus) starts growing into the muscle in the wall of the womb. Cleveland Clinic explains that this makes the womb thicken and enlarge, sometimes up to 2 or 3 times its usual size.

The trapped tissue still responds to the monthly hormone cycle. StatPearls, a medical reference for doctors, explains that it produces more prostaglandins, chemicals that make the womb muscle contract, which leads to painful periods. A larger lining surface and more blood vessels add to heavy bleeding.

How common is it? Estimates vary widely, because many people have no symptoms and, in the past, adenomyosis was only confirmed after a hysterectomy. StatPearls says recent data suggest it affects around 20% to 35% of women.

Is it dangerous? Cleveland Clinic says adenomyosis does not cause or lead to cancer and has no life-threatening dangers. But its symptoms can disrupt daily life, and heavy bleeding can lead to kurang darah (anaemia).

In Malaysia. A 2022 review in the Medical Journal of Malaysia lists adenomyosis among the common causes of heavy menstrual bleeding, together with fibroids. Doctors use a system called PALM-COEIN to sort the causes of abnormal bleeding, and adenomyosis is the “A” in that system.

Simptom adenomyosis (symptoms)

The NHS says symptoms usually affect women over the age of 35, but adenomyosis can affect anyone who has periods. Symptoms include:

When Symptom
During periods Painful periods: the pain may be severe and stop you from doing your usual activities (see our guide to senggugut)
During periods Heavy bleeding. A 2022 review in American Family Physician says heavy menstrual bleeding is the most common symptom; Cleveland Clinic adds that periods can be long and come with clots
Any time in the cycle Pelvic pain (pain in the lower part of your tummy)
Any time in the cycle Bloating, heaviness or fullness in your tummy, sometimes called “adenomyosis belly”
Any time in the cycle Pain during or after sex

What counts as a heavy period? The NHS says you may have heavy periods if you need to change your pad or tampon every 1 to 2 hours, have periods lasting more than 7 days, pass blood clots larger than about 2.5cm, bleed through to your clothes or bedding, or feel tired or short of breath a lot.

Some people have no symptoms at all: about 1 in 3, according to Cleveland Clinic and the American Family Physician review. Cleveland Clinic notes that symptoms tend to get worse over time, but usually go away after menopause, because the tissue depends on oestrogen.

Adenomyosis vs endometriosis vs fibroid

Adenomyosis, endometriosis and fibroids can all cause painful or heavy periods, and they can happen together. The NHS says adenomyosis symptoms can be similar to endometriosis, fibroids, polyps and endometrial hyperplasia (when the womb lining becomes too thick), which is why diagnosis can take time.

Adenomyosis Endometriosis Fibroid
What it is Womb-lining tissue grows into the muscle wall of the womb Tissue similar to the womb lining grows outside the womb, such as on the ovaries or fallopian tubes Common, non-cancerous growths that develop in or around the womb (NHS)
Main symptoms Heavy, painful periods; pelvic pain; bloating Severe period pain, heavy periods, pain in the lower tummy and back, pain during or after sex (NHS); Cleveland Clinic says adenomyosis is more likely than endometriosis to cause heavy bleeding Do not always cause symptoms; can cause heavy or painful periods, stomach pain, lower back pain and needing to pee more often (NHS)
Our guide This page Endometriosis Fibroid

The NHS says you have a higher chance of getting adenomyosis if you have endometriosis. NICE also reminds doctors that pain with heavy periods may be caused by endometriosis rather than adenomyosis, so both may need to be considered.

Who is more likely to get adenomyosis?

The NHS says it is not clear what causes adenomyosis. Cleveland Clinic says research suggests hormones, genetics, inflammation or trauma may contribute. You may be more likely to get it if you:

  • have given birth (NHS);
  • have endometriosis (NHS);
  • are aged 40 to 50, the age at which Cleveland Clinic says it is most common;
  • have had surgery on the womb, such as fibroid removal or a D&C (dilation and curettage), according to Cleveland Clinic.

It is no longer seen as a condition of older women only. Cleveland Clinic says doctors are diagnosing it more often in people in their 30s with abnormal bleeding or painful periods, and the American Family Physician review says younger women with fertility problems are increasingly being diagnosed as scans improve. Cleveland Clinic says there is no known way to prevent adenomyosis.

Diagnosis: adenomyosis ultrasound and MRI

According to the NHS, it can take a long time to diagnose adenomyosis. Your doctor will ask about your periods, may feel your tummy for swelling, and may offer an internal examination. You can ask for a female doctor and bring someone with you.

Adenomyosis ultrasound. NICE recommends offering a transvaginal ultrasound (a small probe gently placed in the vagina) rather than a scan over the tummy or MRI to women with heavy periods who have significant period pain, or a bulky, tender womb that suggests adenomyosis. If a transvaginal scan is not suitable or you decline it, a scan over the tummy or MRI can be considered. StatPearls says signs on ultrasound can include:

  • an uneven (heterogeneous) appearance of the womb muscle;
  • small cysts in the womb muscle;
  • one wall of the womb thicker than the other (asymmetrical thickening);
  • a blurred border between the womb lining and the muscle.

MRI. StatPearls says MRI is more accurate and useful when the ultrasound is unclear or when fibroids or endometriosis are also present. MRI can show a thickened “junctional zone”, the inner layer of the womb muscle.

Test Correctly identified adenomyosis (sensitivity) Correctly ruled it out (specificity)
Transvaginal ultrasound 72% 81%
MRI 77% 89%

Source: a 2010 systematic review of 23 studies with 2,312 women, comparing scans with tissue results. There is no blood test that can diagnose adenomyosis, although StatPearls notes your haemoglobin may be checked if you have heavy periods.

Rawatan adenomyosis (treatment)

The NHS says treatment depends on your symptoms, your age and whether you want to become pregnant. Your doctor will explain the benefits and risks of each option.

Treatment How it helps Things to know
Hormonal coil (IUS, such as Mirena) Thins the womb lining, making periods lighter and less painful (NHS) NICE says to consider it as the first treatment for heavy periods with suspected or diagnosed adenomyosis; StatPearls calls it the most effective first-line hormonal option
Other hormonal contraception The progestogen-only pill, the combined pill or the patch (NHS) Options if you cannot have, or do not want, an IUS; they prevent pregnancy while you use them
Tranexamic acid Reduces heavy bleeding during periods A non-hormonal option
NSAIDs (anti-inflammatory painkillers) Help with period and pelvic pain Ibuprofen is one example; NICE lists NSAIDs and tranexamic acid as non-hormonal options for heavy periods
Uterine artery embolisation Blocks the blood supply to the affected tissue (NHS) Used if other treatments do not work; StatPearls says fertility afterwards cannot be guaranteed
Hysterectomy Removes the womb The NHS says it is the only way to cure adenomyosis, but you will not be able to get pregnant

Cleveland Clinic also describes an operation called adenomyomectomy, which removes adenomyosis from the womb muscle while keeping the womb. StatPearls notes it can increase the risk of the condition coming back and of some pregnancy problems, so it needs careful discussion with a specialist.

Health supplements are not a treatment for adenomyosis. If heavy periods have left you low in iron, your doctor can check your blood and advise whether you need iron.

Easing period pain at home

The NHS suggests these steps for period pain or pelvic pain caused by adenomyosis:

  • use a heat pad or a hot water bottle wrapped in a tea towel on your tummy;
  • try a TENS machine, a small device that uses mild electrical impulses to reduce pain;
  • take painkillers such as paracetamol or ibuprofen.

Our guide to senggugut (period pain) has more tips.

Adenomyosis, fertility and pregnancy

The NHS says adenomyosis can make it difficult to get pregnant and can increase the risk of miscarriage. Cleveland Clinic adds a higher risk of premature labour once you are pregnant. Research findings include:

  • IVF: a 2014 review of 9 studies with 1,865 women found a clinical pregnancy rate of 40.5% in women with adenomyosis, compared with 49.8% in women without it, a 28% lower chance. Miscarriage was more common, in 31.9% compared with 14.1% of pregnancies. The studies varied a lot, so these figures are estimates.
  • In Malaysia: a study of 157 women with endometriosis having IVF at Hospital Sultanah Bahiyah in Alor Setar (2016 to 2022) found that having adenomyosis as well was one of the factors linked to a lower chance of a live birth.

Many women with adenomyosis still have children. If you are planning a pregnancy, tell your doctor early, because some treatments, such as hormonal contraception and hysterectomy, prevent pregnancy. Our guides to ovulasi and keguguran may also help.

When to see a doctor

According to the NHS, see a doctor if:

  • your periods become more painful, heavier or irregular;
  • you have pain during or after sex;
  • heavy periods are affecting your life, or you have had them for some time;
  • you have been feeling bloated for a while (about 3 weeks);
  • you bleed between periods or after sex.

Get urgent medical advice if your pelvic pain or period pain is severe or worse than usual and painkillers have not helped. The NHS also advises seeing a doctor if you have heavy periods with other symptoms, such as pain when peeing, pooing or having sex.

Frequently asked questions (FAQ)

Apa maksud adenomyosis (what is adenomyosis)?

Adenomyosis is where the lining of the womb starts growing into the muscle in the wall of the womb, according to the NHS. Cleveland Clinic explains that this makes the womb thicken and enlarge, and it can cause painful periods, heavy or long periods and pelvic pain. It is not cancer and does not lead to cancer.

Apa simptom adenomyosis (what are the symptoms)?

The NHS lists painful periods, heavy bleeding during periods, pelvic pain, bloating, heaviness or fullness in the tummy, and pain during or after sex. Heavy menstrual bleeding is the most common symptom, according to a 2022 review in American Family Physician. About 1 in 3 people with adenomyosis have no symptoms.

Is adenomyosis the same as endometriosis?

No. In adenomyosis, tissue similar to the womb lining grows into the muscle of the womb. In endometriosis, similar tissue grows outside the womb, in places such as the ovaries or fallopian tubes. Cleveland Clinic says adenomyosis is more likely to cause heavy menstrual bleeding. The two conditions often occur together, and the NHS says you have a higher chance of adenomyosis if you have endometriosis.

Can adenomyosis be seen on ultrasound?

Often, yes. NICE recommends a transvaginal ultrasound (a small probe placed in the vagina) for women with heavy periods and significant period pain or a bulky, tender womb that suggests adenomyosis. A 2010 review found transvaginal ultrasound correctly identified about 72% of women with adenomyosis, while MRI identified about 77%. MRI may be used if the ultrasound is unclear.

Can adenomyosis be cured without surgery?

Treatments such as the hormonal coil (IUS), other hormonal contraception, tranexamic acid and anti-inflammatory painkillers can ease symptoms, but the NHS says removing the womb (a hysterectomy) is the only way to cure adenomyosis. Cleveland Clinic notes that symptoms often go away after menopause.

Can I get pregnant if I have adenomyosis?

Many women with adenomyosis do get pregnant, but the NHS says it can make it difficult to get pregnant and can increase the risk of miscarriage. In a 2014 review of IVF studies, the clinical pregnancy rate was 40.5% in women with adenomyosis compared with 49.8% in women without it. If you are trying for a baby, ask your doctor which treatments suit you.

When should I see a doctor about adenomyosis?

The NHS advises seeing a doctor if your periods become more painful, heavier or irregular, you have pain during or after sex, heavy periods are affecting your life, you have felt bloated for about 3 weeks, or you bleed between periods or after sex. Get urgent advice if your pelvic or period pain is severe or worse than usual and painkillers have not helped.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

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