What Is Adenomyosis?

Quick Facts

• Adenomyosis affects up to 1 in 5 women
• It’s often mistaken for endometriosis or fibroids
  Symptoms overlap, but adenomyosis is a distinct condition affecting the uterine muscle itself.
• You don’t need severe symptoms to have adenomyosis
  Some people experience debilitating pain and bleeding, while others remain asymptomatic.
• Diagnosis has improved – but delays are still common
  Advances in ultrasound and MRI mean adenomyosis can now be identified earlier, without surgery.
• Symptoms can often be managed without surgery
  Hormonal support, inflammation control, and personalised treatment plans can significantly improve quality of life.

What Is Adenomyosis?

Adenomyosis is a gynaecological condition where tissue like the lining of the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium).

While it shares similarities with endometriosis, adenomyosis is a separate condition -and can be just as painful and disruptive.

Although it can affect womens at any reproductive age, adenomyosis is most commonly diagnosed in women in their 30s and 40s, particularly those who have had children.

That said, we now know it can occur earlier – and may be contributing to symptoms long before diagnosis.

What’s Actually Happening?

In a healthy menstrual cycle, the endometrial lining thickens in response to hormones and sheds during menstruation (the bleed).

In adenomyosis, endometrial-like tissue becomes embedded within the uterine muscle.

Each month, this tissue still responds to hormonal signals – swelling and breaking down – but because it’s trapped within the muscle wall, it can’t shed normally.

This leads to:

• Chronic uterine inflammation
• Thickening of the uterine walls
• Increased uterine pressure and tenderness
• Heightened pain signalling from the pelvis

Over time, the uterus may become enlarged, heavy, and increasingly sensitive -contributing to both physical discomfort and systemic fatigue.

Common Symptoms of Adenomyosis

Symptoms vary widely, but may include:

• Heavy or prolonged periods (menorrhagia)
• Severe menstrual cramps (dysmenorrhoea)
• Chronic pelvic pain or pressure
• Pain during or after sex
• Bloating or a sensation of pelvic heaviness
• Fatigue and low energy (often linked to blood loss and inflammation)

Importantly, some people have no obvious symptoms at all.

In these cases, adenomyosis may only be identified during investigations for fertility concerns, recurrent miscarriage, or unexplained pelvic pain.

How Is Adenomyosis Diagnosed?

Adenomyosis is frequently underdiagnosed – often confused with fibroids, endometriosis, or dismissed as “normal” period pain.

Diagnosis may involve:

• Pelvic examination (to assess uterine size and tenderness)
• Transvaginal ultrasound (looking for characteristic changes in the uterine muscle)
• MRI, which offers the most detailed imaging when diagnosis is unclear

Historically, adenomyosis was only confirmed after hysterectomy.

Thankfully, this is no longer necessary, and imaging advances now allow for diagnosis while preserving fertility.

Treatment & Management Options

There is no single “cure” for adenomyosis — but symptoms can often be managed effectively.

Treatment options may include:

• Hormonal support (e.g. hormonal IUDs, oral contraceptives, GnRH analogues)
• Anti-inflammatory medications (NSAIDs)
• Tranexamic acid to reduce heavy bleeding
• Surgical options in severe or refractory cases (e.g. endometrial ablation or hysterectomy)

The right approach depends on:

• Symptom severity
• Age and hormonal stage
• Fertility goals
• Overall health and inflammatory burden

At Atlas, we recognise that adenomyosis doesn’t exist in isolation.

Hormone balance, iron status, inflammation, thyroid function, and metabolic health all play a role in symptom expression and resilience.

Final Thoughts

Adenomyosis is a real, life-affecting condition – but it’s still too often overlooked or normalised.

If you’re experiencing heavy bleeding, severe cramps, persistent pelvic pain, or unexplained fatigue, your symptoms deserve investigation.

With the right insight and support, many people are able to reduce symptoms, protect fertility, and regain quality of life.

Understanding what’s happening beneath the surface is the first step toward meaningful change.