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 may collect a sample of uterine tissue for testing (endometrial biopsy) to verify that your abnormal uterine bleeding isn't associated with any other serious condition. But, an endometrial biopsy won't help your doctor confirm a diagnosis of adenomyosis. The only way to be certain of adenomyosis is to examine the uterus after surgery to remove it (hysterectomy).
Other uterine diseases can cause signs and symptoms similar to adenomyosis, making adenomyosis difficult to diagnose. Such conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps). Your doctor may conclude that you have adenomyosis only after determining there are no other possible causes for your signs and symptoms.
Adenomyosis usually goes away after menopause, so treatment may depend on how close you are to that stage of life.
Treatment options for adenomyosis include:
- Anti-inflammatory drugs. If you're nearing menopause, your doctor may have you try anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take 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 may 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 may provide symptom relief.
- Hysterectomy. If your pain is severe and menopause is years away, your doctor may suggest surgery to remove your uterus (hysterectomy). Removing your ovaries isn't necessary to control adenomyosis.
Lifestyle and home remedies
To ease pelvic pain and cramping related to adenomyosis:
- 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. To save time and make sure you cover everything you want to discuss, it's a good idea to prepare for your appointment.
What you can do
Before your appointment:
- Write down any symptoms you're experiencing. Include those that may seem unrelated to your condition.
- Make a list of any medications or vitamin supplements you take. Write down doses and how often you take them.
- Take a notebook or electronic notepad with you. Use it to write down important information during your visit.
- Think about questions to ask your doctor. Write down any questions, listing the most important ones first.
For adenomyosis, some basic questions to ask your doctor include:
- How is adenomyosis diagnosed?
- How much experience do you have in diagnosing and treating adenomyosis?
- Are there any medications I can take to improve my symptoms?
- What side effects can I expect from medication use?
- Under what circumstances do you recommend surgery?
- Will I take a medication before or after surgery?
- Could my condition affect my ability to become pregnant?
- Are there any alternative treatments I might try?
Don't hesitate to ask your doctor to repeat information or to ask follow-up questions.
What to expect from your doctor
Some questions your doctor might ask include:
- How long have you been experiencing symptoms?
- 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?
- Do your symptoms seem to be related to your menstrual cycle?
- Does anything seem to improve your symptoms?
- Does anything make your symptoms worse?
April 02, 2015
- Stewart EA. Uterine adenomyosis. http://www.uptodate.com/home. Accessed Jan. 22, 2015.
- Benacerraf BF, et al. Gynecologic Ultrasound: A Problem-Based Approach. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 22, 2015
- Uterine adenomyosis. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/gynecology_and_obstetrics/benign_gynecologic_lesions/uterine_adenomyosis.html. Accessed Jan. 22, 2015.
- Cockerham AZ. Adenomyosis: A challenge in clinical gynecology. Journal of Midwifery and Women's Health. 2012;57:212.
- Garcia L, et al. Adenomyosis: Review of the literature. Journal of Minimally Invasive Surgery. 2011;18:428.
- Benagiano G. The pathophysiology of uterine adenomyosis: An update. American Society for Reproductive Medicine. 2012;98:572.
- Benagiano G, et al. Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Human Reproduction Update. 2014;20:386.
- Laughlin-Tommaso SK (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 4, 2015.