For many women, painful periods may be caused by a common yet often overlooked condition known as adenomyosis.
What is adenomyosis?
Adenomyosis occurs when tissue similar to the lining of the uterus — called the endometrium — grows into the muscular wall of the uterus.
Each month during menstruation, this tissue responds to hormones just like the normal uterine lining. It thickens and bleeds, leading to inflammation, swelling, pain, and heavy menstrual bleeding.
Over time, the uterus may become enlarged, tender, and painful.
Since COVID-19 and the COVID vaccine, I must comment that I have seen an increase in such cases.
What symptoms can
it cause?
Some symptoms can be:
* Heavy or prolonged menstrual bleeding
* Severe menstrual cramps
* Chronic pelvic pain or pressure
* Pain during intercourse
* Bloating or a sensation of heaviness in the pelvis
* Fatigue caused by anemia from excessive blood loss
* Infertility
Many women report that their periods become progressively heavier and more painful over time.
Who is most affected?
Adenomyosis most commonly affects women between 35 and 50, especially those who have had children, but it can also be seen in some younger women.
The condition is sometimes associated with previous uterine procedures such as:
• ↓Caesarean section
• ↓Fibroid surgery
• ↓Dilation and curettage (D&C)
Adenomyosis may also occur alongside endometriosis or uterine fibroids.
What causes adenomyosis?
The exact cause of adenomyosis remains uncertain. Researchers believe several factors may contribute, including:
• ↓Hormonal influences, especially estrogen
• ↓Inflammation of the uterus after childbirth
• ↓Prior uterine surgery
• ↓Disruption between the lining of the uterus and the muscular wall
• ↓Invasion of endometrial tissue into the uterine muscle
How is adenomyosis diagnosed?
In the past, adenomyosis was usually confirmed only after a hysterectomy, when the uterus was examined under a microscope. Today, however, modern imaging techniques done by the experts, such as transvaginal ultrasound and MRI scans, can often diagnose or strongly suggest the condition.
Doctors may suspect the condition when a woman reports heavy, painful periods together with an enlarged or tender uterus during examination.
Because symptoms overlap with fibroids and endometriosis, adenomyosis may sometimes be mistaken for other conditions. However, the classic ultrasound findings confirm the diagnosis.
Is adenomyosis dangerous?
Adenomyosis is not cancerous and does not increase the risk of uterine cancer.
However, it can significantly affect a woman’s quality of life because of the symptoms it causes.
What treatments are available?
Modern treatment approaches now focus not only on symptom relief, but also on preserving fertility and avoiding unnecessary hysterectomies whenever possible.
Pain relief medications
Anti-inflammatory medications such as ibuprofen or naproxen may help reduce menstrual cramps and pelvic pain.
Hormonal treatments
Hormonal therapy is now considered one of the main treatments for adenomyosis and can significantly improve symptoms in many women.
Options include:
• ↓Birth control pills
• ↓Progesterone-only medications
• ↓Dienogest therapy
• ↓Hormonal intrauterine devices (IUDs), such as the Mirena IUD
The hormonal IUD has become one of the most effective first-line treatments because it can reduce both pain and heavy bleeding.
In more severe cases, doctors may use medications known as GnRH agonists or GnRH antagonists to temporarily suppress estrogen production and shrink adenomyosis-related tissue.
These treatments are usually used for limited periods under specialist supervision.
Non-surgical procedures
Some women who wish to preserve the uterus may benefit from newer minimally invasive procedures such as:
• ↓Uterine artery embolisation (UAE)
• ↓High-intensity focused ultrasound (HIFU)
These treatments are not suitable for every patient but may provide relief in selected cases.
Surgery
For women with severe symptoms who no longer wish to become pregnant, hysterectomy — surgical removal of the uterus — remains the only definitive cure.
However, modern gynaecology increasingly emphasises individualised treatment plans and uterus-preserving options whenever appropriate.
When should women seek medical attention?
Women should not ignore:
• ↓Very heavy menstrual bleeding
• ↓Severe menstrual pain
• ↓Bleeding between periods
• ↓Pain during intercourse
• ↓Pelvic pressure
• ↓Fatigue related to heavy blood loss
Early diagnosis can help women avoid years of unnecessary suffering and improve both physical and emotional well-being. See your gynaecologist if you have any of these symptoms so you can be offered options.
MDW, MBBS, DGO, DM, FACOG
Specialist Obstetrician & Gynaecologist
