Adenomyosis

Adenomyosis is a condition where tissue similar to the lining of the uterus grows into the muscular wall of the uterus itself, rather than staying confined to the inner lining. This can cause the uterus to thicken and enlarge. It is common, thought to affect around a fifth of people at some point, and often causes no symptoms at all.

Symptoms

When it does cause symptoms, the most common are heavy periods, painful periods, and bleeding between periods. Symptoms most often show up in the late 30s to 40s, though adenomyosis can be present without any symptoms at a younger age too.

How it affects fertility

Diagnosis

Adenomyosis is usually diagnosed with a transvaginal ultrasound or an MRI, both of which are considered similarly reliable. There is no blood test for it.

Treatment options

Treatment depends on whether the main goal is symptom relief or improving fertility.

• Hormonal treatments, such as the combined pill, a progestin, or a hormone-releasing IUD, can reduce symptoms but are generally paused when trying to conceive.
• GnRH agonist treatment before an IVF cycle is the most studied fertility-focused approach, aiming to quiet the adenomyosis before a frozen embryo transfer.
• Surgery to remove affected tissue is possible in some cases but is more complex than fibroid surgery, since adenomyosis does not have a clear border with healthy tissue.