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Adenomyosis: Symptoms, Causes, Diagnosis and Treatment Options

By Dr. Divya J G • 02 November 2026

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Medically reviewed by: Dr. Divya J G, MBBS, MS (OBG), DNB, FMAS, FRM, Consultant Obstetrician and Gynaecologist Last reviewed: 27 October 2026

Heavy periods that soak through pads, cramps that make you cancel plans and a heavy, bloated feeling in the lower belly are often dismissed as “just periods”. For many women in their thirties and forties, one cause is adenomyosis, a common but under-recognized condition of the uterus. It is often confused with endometriosis and fibroids, and a missed diagnosis can mean years of suffering and anemia. This guide explains what adenomyosis is, how to recognize it, how it is diagnosed and the treatments available, including options for women who wish to conceive.

Key points: In adenomyosis, tissue like the uterine lining grows into the muscular wall of the uterus, making it thick and tender. The usual signs are heavy, long periods and severe, worsening period pain. About a third of women have no symptoms. Diagnosis is made with a pelvic ultrasound, sometimes an MRI. Treatment ranges from medicines and a hormonal IUD to uterus-preserving procedures and, when family is complete, hysterectomy.

What Is Adenomyosis?

The inside of the uterus is lined by a layer called the endometrium, which thickens each month and is shed as a period. In adenomyosis, endometrial tissue grows inside the muscle layer (myometrium) of the uterus. Each month, this tissue behaves as it does in the lining: it thickens and bleeds, but it is trapped within the muscle. The uterus can become enlarged, boggy and tender.

Adenomyosis is not cancer. It is most often diagnosed in women aged 35 to 50, and it is more common in women who have had children. It can also affect younger women.

Adenomyosis Symptoms

Heavy periods, with large clots and bleeding that lasts longer than 7 days
Severe cramping and pelvic pain that gets worse over the years
Long-lasting, dull pelvic pain between periods
Pain during intercourse
A feeling of heaviness, bloating or pressure in the lower abdomen, and sometimes a larger uterus on examination
Tiredness, dizziness or breathlessness due to anemia from blood loss
Difficulty conceiving or repeated miscarriage in some women
No symptoms at all in about one in three women

Anemia is a particular concern in India, where more than half of women aged 15 to 49 are anemic, according to NFHS-5 (2019 to 2021). Heavy bleeding can worsen it, so do not ignore tiredness or breathlessness.

What Causes Adenomyosis?

The exact cause is not known. Possible explanations include:

Endometrial tissue invading the muscle wall from the lining
Tissue left behind after a previous uterine surgery such as a C-section or D and C
Inflammation of the uterus after childbirth
Hormonal influences, particularly estrogen, since adenomyosis usually improves after menopause

Adenomyosis often occurs with fibroids or endometriosis, which can make it harder to recognize.

Adenomyosis vs Endometriosis vs Fibroids

	Adenomyosis	Endometriosis	Fibroids
What it is	Lining-like tissue inside the uterine muscle	Lining-like tissue outside the uterus (ovaries, pelvis, bowel)	Non-cancerous muscle lumps in or on the uterus
Typical age	35 to 50	20s to 40s	30s to 50s
Main symptoms	Heavy, long periods, severe cramps, enlarged tender uterus	Severe period and pelvic pain, pain in intercourse, infertility	Heavy bleeding, pressure, frequent urination, sometimes no symptoms
Uterus on scan	Diffusely enlarged, thick wall, no distinct lump	Usually normal size, ovarian cysts may be seen	Distinct round masses
Usual diagnosis tools	Ultrasound, MRI	Ultrasound, MRI, laparoscopy	Ultrasound, MRI
Related page	This guide	Endometriosis management	Fibroids and cysts

More than one condition can be present at the same time.

How Adenomyosis Is Diagnosed

History and pelvic examination: the doctor may feel a larger, tender uterus
Transvaginal ultrasound: the usual first test. Findings that suggest adenomyosis include a thickened uterine wall, uneven muscle texture, small cysts within the muscle and a poorly defined border between lining and muscle
MRI of the pelvis: more detailed, and helpful when the ultrasound is unclear or when planning treatment, particularly to tell adenomyosis from fibroids
Blood tests: hemoglobin and iron levels to check for anemia, and other tests to rule out other causes of heavy bleeding
Endometrial biopsy or hysteroscopy: in some women to exclude other causes such as polyps or abnormal lining
Definitive confirmation: historically made by examining the uterus after hysterectomy. Imaging is now accepted for diagnosis in most women

How to Read Your Ultrasound or MRI Report

Reports may say “globular uterus”, “heterogeneous myometrium”, “myometrial cysts”, “asymmetric thickening of the posterior wall” or “thickened junctional zone”. These phrases can suggest adenomyosis, but they must be interpreted with your symptoms. Not every report with these words means treatment is needed, and not every woman with symptoms has a clear report. Always discuss the report with your gynecologist.

Adenomyosis Treatment

Treatment depends on your symptoms, age, whether you want to conceive and how much the condition affects your life.

Treatment	What it does	Notes
Pain medicines (NSAIDs)	Reduce cramps and bleeding in some women	Taken as advised, usually around periods
Tranexamic acid	Reduces heavy bleeding	Taken during periods
Iron and anemia treatment	Treats blood loss	Essential if hemoglobin is low
Hormonal intrauterine system (levonorgestrel IUS)	Reduces bleeding and pain	Often a first-line option for many women
Hormonal pills, progestins	Control periods and pain	Different options with different side effects
GnRH medicines	Temporarily stop periods and shrink the uterus	Short-term, with menopausal-type side effects
Uterine artery embolization	Blocks blood supply to reduce symptoms	For selected women who wish to keep the uterus
Focused energy treatments	Targeted heating of the area	Available in selected centers, with limited long-term data
Adenomyomectomy (surgery to remove the affected area)	Removes a localized adenomyosis lump	Selected women who want to keep fertility. Technically demanding
Hysterectomy	Removes the uterus	Definitive treatment when family is complete. See our guide to laparoscopic hysterectomy

There is no single option that suits everyone. Many women do well with medicines and a hormonal IUD for years. Your doctor will explain the benefits, side effects and limits of each option.

Adenomyosis and Pregnancy

Adenomyosis may reduce the chance of conceiving in some women, and is associated with a higher risk of miscarriage and pregnancy complications in some studies. Many women with adenomyosis do conceive and have healthy pregnancies, naturally or with fertility treatment. If you want a baby, discuss your plans before starting treatment, because some medicines prevent pregnancy. A fertility specialist and gynecologist can plan together. See infertility care.

Living With Adenomyosis

Track your periods and pain in a diary to show your doctor
Use heat packs and gentle exercise for cramps
Eat iron-rich foods, such as leafy vegetables, legumes, dates and jaggery, and take iron if prescribed
Rest when needed, and tell your employer or family if you need support
Seek support for emotional strain, since chronic pain can affect mood

See a doctor soon if you soak a pad every hour for several hours, pass very large clots, feel dizzy or faint, have severe pain that stops you from working, have persistent pelvic pain between periods, or have been trying to conceive for 6 to 12 months with painful, heavy periods.

Adenomyosis Care in BTM Layout, Bangalore

The Obstetrics and Gynecology department at Genesiss Hospital, BTM Layout, evaluates heavy and painful periods, arranges ultrasound and other tests and discusses treatment options in a private consultation. We are at 17, 100 Feet Ring Road, near Jayadeva Metro, BHBCS Layout, BTM 2nd Stage, Bengaluru 560076, and women visit from Jayanagar, JP Nagar, Koramangala, HSR Layout and Bannerghatta Road. See our Obstetrics and Gynecology department or the page on irregular and heavy periods, or call +91 98867 77592.

Frequently Asked Questions

What are the symptoms of adenomyosis?

Heavy and long periods, severe and worsening cramps, pelvic pain between periods, pain during intercourse, a heavy feeling in the lower belly and tiredness from anemia. Some women have no symptoms.

What is the difference between adenomyosis and endometriosis?

In adenomyosis, lining-like tissue grows into the muscle wall of the uterus. In endometriosis, similar tissue grows outside the uterus. They can occur together.

Can adenomyosis be treated without a hysterectomy?

Yes, in many women. Options include medicines, a hormonal IUD, hormonal treatments and, in selected cases, uterine artery embolization or surgery to remove the affected area. Hysterectomy is the definitive option when the family is complete.

Does adenomyosis affect fertility?

It may make conceiving harder in some women and raise the risk of miscarriage, but many women conceive. Discuss your plans with a gynecologist and a fertility specialist.

How is adenomyosis diagnosed?

Usually by transvaginal ultrasound and sometimes MRI, together with your symptoms and examination.

Does adenomyosis go away after menopause?

Symptoms usually improve after menopause, because the condition depends on estrogen.

Is adenomyosis cancer?

No, adenomyosis is a non-cancerous condition. Your doctor may do tests to rule out other causes of heavy bleeding.

Visit Genesiss Hospital, BTM Layout

17, 100 Feet Ring Road, near Jayadeva Metro, BHBCS Layout, BTM 2nd Stage, BTM Layout, Bengaluru, Karnataka 560076.

Phone: +91 98867 77592 | Email: contact@genesisshospital.com

Emergency and trauma care are available round the clock.

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This article is for general health information. It is not a substitute for examination, diagnosis or treatment by a qualified doctor. If you think you may have an emergency, go to the nearest emergency department or call the hospital.