Adenomyosis

What is adenomyosis?

Adenomyosis is a condition in which tissue similar to the lining of the womb (endometrium) grows into the muscle wall of the uterus (myometrium). This tissue continues to respond to monthly hormones, causing the uterine wall to thicken, swell and become painful. Adenomyosis can be diffuse, spread through much of the uterus, or focal, forming a localised mass called an adenomyoma. It often occurs alongside endometriosis or fibroids and is increasingly recognised in women with infertility.

Symptoms and signs

• Painful periods that may become worse over time
• Heavy or prolonged menstrual bleeding
• Chronic pelvic pain or pressure
• Pain during intercourse
• An enlarged, tender uterus on examination
• Difficulty conceiving, failed embryo transfers or miscarriage

Around one-third of women with adenomyosis have no symptoms.

Causes and risk factors

The exact cause is not known. One theory is that the boundary between the lining and the muscle is disrupted, allowing lining tissue to grow inward. Risk factors include previous uterine surgery such as caesarean section, D&C or myomectomy, having had children, increasing age, and the presence of endometriosis. Adenomyosis may affect fertility by altering the uterine muscle contractions, causing inflammation and changing the environment for implantation.

How adenomyosis is diagnosed

• Transvaginal ultrasound, which can show typical features such as an asymmetric, thickened uterine wall, small cysts in the muscle and poorly defined boundaries
• 3D ultrasound to assess the junctional zone between lining and muscle
• MRI, which is helpful when the ultrasound is unclear or when surgery is being planned
• Assessment for associated endometriosis and fibroids
• Ovarian reserve tests and semen analysis as part of a complete fertility workup

Treatment options

Symptom control

Pain medicines and hormonal treatments such as the hormonal intrauterine system (LNG-IUS) or progestogens can control pain and bleeding, but they prevent pregnancy while used, so they suit women who are not currently trying to conceive.

Down-regulation before embryo transfer

For women having IVF, some specialists use GnRH agonist injections for two to three months to shrink adenomyosis before a frozen embryo transfer. Evidence suggests this may help in some women, although high-quality studies are still limited.

Surgery

Uterus-sparing surgery to remove a focal adenomyoma is occasionally considered in selected cases, but it is complex and can weaken the uterine wall, which raises the risk of uterine rupture in pregnancy. Hysterectomy treats adenomyosis but is not an option for women wanting children.

IVF

IVF, often with freezing of all embryos and a later transfer after down-regulation, is commonly used for women with adenomyosis and infertility, especially when there is also endometriosis or reduced ovarian reserve.

Chances of pregnancy

Many women with adenomyosis do become pregnant. Studies suggest adenomyosis may reduce implantation and increase the risk of miscarriage, and the effect is likely greater with more extensive disease. Age and ovarian reserve remain key factors. Your specialist can discuss your individual chances, which cannot be guaranteed.

When to see a fertility specialist

See a specialist if you have painful, heavy periods and difficulty conceiving, if a scan has suggested adenomyosis, or if you have had failed embryo transfers. Iswarya Fertility has 91+ centres, with EMI options from ₹9,999 per month for eligible treatments.