Diagnosis

Your doctor may suspect adenomyosis based on:

  • Signs and symptoms
  • A pelvic exam that reveals an enlarged, tender uterus
  • Ultrasound imaging of the uterus
  • Magnetic resonance imaging (MRI) of the uterus

In some instances, your doctor might collect a sample of uterine tissue for testing (endometrial biopsy) to verify that your abnormal uterine bleeding isn't associated with another serious condition. But an endometrial biopsy won't help your doctor confirm a diagnosis of adenomyosis.

The only way to confirm adenomyosis is to examine the uterus after hysterectomy. However, pelvic imaging such as ultrasound and MRI can detect signs of it.

Other uterine diseases can cause signs and symptoms similar to adenomyosis, making adenomyosis difficult to diagnose. Conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps).

Your doctor might conclude that you have adenomyosis only after ruling out other possible causes for your signs and symptoms.

Treatment

Adenomyosis often goes away after menopause, so treatment might depend on how close you are to that stage of life.

Treatment options for adenomyosis include:

  • Anti-inflammatory drugs. Your doctor might recommend anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine one to two days before your period begins and taking it during your period, you can reduce menstrual blood flow and help relieve pain.
  • Hormone medications. Combined estrogen-progestin birth control pills or hormone-containing patches or vaginal rings might lessen heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device, or continuous-use birth control pills often lead to amenorrhea — the absence of your menstrual periods — which might provide some relief.
  • Hysterectomy. If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus. Removing your ovaries isn't necessary to control adenomyosis.

Lifestyle and home remedies

To ease pelvic pain and cramping related to adenomyosis, try these tips:

  • Soak in a warm bath.
  • Use a heating pad on your abdomen.
  • Take an over-the-counter anti-inflammatory medication, such as ibuprofen (Advil, Motrin IB, others).

Preparing for your appointment

Your first appointment will be with either your primary care provider or your gynecologist.

What you can do

Make a list of:

  • Your signs and symptoms, and when they began
  • All medications, vitamins and other supplements you take, including doses
  • Medical information, including menstrual and childbirth history
  • Questions to ask your doctor

For adenomyosis, basic questions to ask your doctor include:

  • Are there medications I can take to improve my symptoms?
  • Under what circumstances do you recommend surgery?
  • Could my condition affect my ability to become pregnant?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor might ask you:

  • When do symptoms typically occur?
  • How severe are your symptoms?
  • When was your last period?
  • Could you be pregnant?
  • Are you using a birth control method? If so, which one?
  • Do your symptoms seem to be related to your menstrual cycle?
  • Does anything seem to improve your symptoms?
  • Does anything make your symptoms worse?
June 08, 2018
References
  1. Stewart EA. Uterine adenomyosis. https://www.uptodate.com/contents/search. Accessed April 3, 2018.
  2. Uterine adenomyosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/uterine-adenomyosis. Accessed April 3, 2018.
  3. Abbott JA, et al. Adenomyosis and abnormal uterine bleeding (AUB-A) — Pathogenesis, diagnosis and management. Best Practice & Research Clinical Obstetrics and Gynaecology. 2017;40:68.