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21st April 2021

Adenomyosis: symptoms and diagnosis

What are the symptoms of Adenomyosis?

 The symptoms of adenomyosis, a common yet under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall, may vary, and in fact, many women may not display any symptoms at all.

Here we highlight the symptoms of adenomyosis which can cause severe period pain and cramps and may include:

  • Typically heavy and painful periods;
  • A lump felt in the lower abdomen (as the uterus may become so enlarged);
  • Urinary frequency and constipation – caused by pressure on the bladder and bowel due to having an enlarged uterus.

April is Adenomyosis Awareness Month and it is important we shine a light on a condition that many women live with, without ever having a diagnosis. A lot of women with adenomyosis have such bad periods that they have to put their life on hold during their time of the month. It affects their work and quality of life significantly. It can lead to anaemia due to heavy bleeding and lead to extreme tiredness and also affect performance at work and sports.

During menstruation, the adenomyotic tissue swells up in addition to the uterine lining and bleeds within the uterine wall which can lead to severe period pain, cramps and heavy periods.

There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall whereas it grows outside the uterus with endometriosis.

How is adenomyosis diagnosed?

This condition can be difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women have heavy and painful periods and accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be.

The condition is often diagnosed on an ultrasound or MRI scan where an enlarged uterus is seen with one wall of the uterus thicker than the other.

You can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anemic.

What are the treatment options available?

Adenomyosis can be a difficult condition to treat. To make the periods less painful, supportive treatment is often the first line of management with medication (painkillers and antispasmodic medication such as Mefenamic Acid) and to reduce the bleeding (Tranexamic Acid). Sometimes taking the minipill or the contraceptive pill back to back can also stop the periods and hence help with the symptoms. Mirena intrauterine device is also helpful in reducing the symptoms significantly. The condition also improves during and after pregnancy and after menopause.

Uterine artery embolisation (UAE) is a treatment usually reserved for fibroids but is also very effective for treating adenomyosis.  The uterine blood supply is blocked by an interventional procedure carried out through the groin blood vessels. Hysterectomy is often reserved for extreme cases where the symptoms are resistant to other forms of treatment and the family is complete.

Make an appointment:

At London Gynaecology, our consultants provide diagnosis of and see patients for the treatment of adenomyosis at our practice locations at The Portland Hospital and at our new opening in the City of London.  To book a consultation please email our team on [email protected] or call 0207 10 11 700 (24hrs).

To learn more about our adenomyosis package, click here.

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