Adenomyosis is a benign condition that affects the uterus. Cells similar to the endometrium, which is the lining of the uterus, are found inside the muscular wall of the uterus. This can make the uterus larger, more sensitive and more painful, especially during menstruation.
Adenomyosis is common in women in their thirties and forties, especially in those who have had pregnancies. It often coexists with other benign uterine diseases such as fibroids and endometrial polyps.
In Lisbon, Dra. Joana Faria offers consultations for adenomyosis in Portuguese, English, French, and Spanish. The aim is to understand your symptoms, confirm the diagnosis and build a plan that takes into account your life today and your future projects.
On this page you will find an overview of adenomyosis. For more information on related conditions you can also read the pages on myomas (uterine fibroids), endometriosis and the general page on reproductive tract diseases.
What it is
In a normal uterus, the endometrium lines the inside of the cavity and is shed during menstruation. In adenomyosis, endometrial tissue is also present inside the muscle of the uterus, called the myometrium.
Each month, this tissue reacts to hormones like normal endometrium. Because it is trapped inside the muscle, it can cause inflammation, swelling and microscopic bleeding. The result is often a heavier and more painful period and a feeling of pressure in the pelvis.
Adenomyosis can be diffuse, affecting the whole uterus, or focal, forming adenomyomas that resemble fibroids. Many women with adenomyosis also have small fibroids or endometrial polyps at the same time.
Main symptoms and when to worry
Not all women with adenomyosis have symptoms. When they appear, the most frequent are:
- Strong menstrual pain that may start a few days before the period and continue after it ends.
- Heavy or prolonged periods, sometimes with clots.
- Spotting or brown discharge before the period starts.
- Pelvic pain or a feeling of weight in the lower abdomen, even outside menstruation.
- Pain during sexual intercourse, especially deep penetration.
- More tiredness due to anaemia caused by heavy bleeding.
You should consider a consultation if you notice:
- Periods that are much more painful or heavier than they used to be.
- Pain that does not improve with simple painkillers taken correctly.
- Bleeding that lasts more than 7 days most of the time.
- Spotting before the period that persists for several months.
- Pain that interferes with sleep, work, study or intimacy.
You should seek urgent care if you have sudden intense pelvic pain, pain with fever and strong malaise or very heavy bleeding with dizziness or fainting. These can be signs of a different problem that needs immediate evaluation.
Diagnosis: exams and what to expect
Adenomyosis is suspected by combining your symptoms with imaging exams. In the past, it was diagnosed mainly after hysterectomy. Today, high quality ultrasound and MRI often allow a confident diagnosis without surgery.
During a consultation, the evaluation may include:
- Clinical history
Questions about your menstrual cycle, pain, bleeding pattern, pregnancies, previous surgeries and treatments already tried. - Gynecologic examination
Assessment of the vulva, vagina and cervix and bimanual palpation to evaluate the size and sensitivity of the uterus. - Transvaginal pelvic ultrasound
Key exam to study the uterine wall. Adenomyosis can give a characteristic appearance, with a thicker and less regular myometrium and small cystic spaces inside it. - Pelvic MRI
In selected cases, MRI can confirm the diagnosis, show how extensive adenomyosis is and distinguish it from fibroids. - Blood tests
Evaluation of anaemia, iron stores and sometimes hormones, especially when there are cycle alterations.
It is common for experiments to mention several findings at the same time, such as adenomyosis and fibroids. Dra. Joana Faria will explain which of these seems to be most related to your symptoms and what each one means for your treatment options.
Treatment options and realistic expectations
Treatment for adenomyosis is always individual. It depends on your age, how severe your symptoms are, your plans regarding pregnancy and whether you have other uterine diseases such as fibroids.
Broadly, the options include:
- Watchful waiting
For women with mild symptoms close to menopause, careful follow up with pain control can be a safe choice. Hormone levels naturally decrease over time, which may reduce symptoms. - Medical treatment
Hormonal contraception, progestins, hormone releasing intrauterine devices and other medicines can reduce menstrual pain and bleeding. They are less invasive than surgery, but require regular use and may have side effects that need monitoring. - Interventional or surgical options
In women with very strong symptoms who do not plan more pregnancies, hysterectomy can be a definitive solution. In selected cases, adenomyosis can be treated with conservative surgery or interventional radiology techniques, depending on the location and the desire to preserve fertility. - Combined approach
Often, the best results come from combining medical and surgical strategies and adapting the plan over time.
It is important to know that some treatments improve symptoms significantly but may not remove them completely. For many women, the goal is to reduce pain and bleeding to a level that allows a normal life rather than to reach absolute zero symptoms.
How Dra. Joana Faria approaches adenomyosis in practice
Dra. Joana Faria knows that the word adenomyosis is not familiar to many women and can sound alarming. Her approach is to explain clearly what is happening in your uterus and what is realistic to expect from each treatment.
In daily practice she:
- Starts by listening to how your periods and pain affect your day to day life.
- Reviews ultrasound or MRI images with you so that you can see what the reports describe.
- Explains how adenomyosis differs from fibroids and endometriosis and how they can coexist.
- Helps you choose between options that protect your fertility and options that give more definitive control of symptoms.
- Builds a step by step plan, with room to adjust treatment if your life circumstances change.
The aim is for you to feel informed and supported, instead of feeling that you have to choose between living with pain or facing major surgery without alternatives.
