While endometriosis is sadly something many of us are all too familiar with, not as much is known about adenomyosis, but when it comes to adenomyosis vs endometriosis, it's important to know the differences.
Whether endometriosis is something you suffer from and you want to know more about it, or are curious about adenomyosis and how it can impact your fertility if you're trying to conceive, we've put together everything you need to know about the difference between adenomyosis vs endometriosis including the symptoms, diagnosis and treatment with expert help and advice from Dr. Amit Shah, leading gynaecologist and co-founder of Fertility Plus.
What is the difference between adenomyosis and endometriosis?
The endometrium is the tissue inside the uterus that sheds during menstruation. If tissue similar to that of inside the uterus grows where it shouldn’t, this can lead to conditions known as endometriosis and adenomyosis. It’s important to know that while they share some symptoms, they affect different areas of the body and may often require different treatments. It’s also possible to have both conditions at once.
With endometriosis, the type of cells lining the uterus, begin growing outside of it. This growth can consequently breach close by organs e.g. ovaries, bladder and Fallopian tubes, thus making conception more difficult.
Conversely, adenomyosis occurs when the type of cells lining the uterus begin growing very deep inside the wall of the uterus, causing it to thicken.
How do the symptoms differ?
As your uterine lining begins growing in thickness as your menstrual cycle progresses, and then sheds during your bleed, this can cause symptoms to flare.
Those suffering from endometriosis symptoms will experience potentially irritated and swollen tissue near the uterine lining, leading to a combination of the below symptoms:
• Stomach pain is the most common symptom, and may worsen closer to menstruation
• Back pain
• Pain during and after sex
• Pain during emptying bowels / peeing
• Nausea and vomiting
Adenomyosis causes the inside of the womb to thicken and enlarge, potentially leading to:
• Uterine muscle contractions
• Heavy and painful menstruation
• Pressure on the bladder and rectum
As both conditions may cause anaemia due to heavy menstrual bleeding, iron supplementation may be necessary for some women.
What are the causes of adenomyosis vs endometriosis?
At this stage, we don’t know what causes either. However, certain factors may make some women more susceptible to experiencing either.
Your chances of getting endometriosis may increase if:
• You have a heavy flow lasting 7+ days
• Female relatives in your family have it
• You’re in your 30s / 40s
• Your period began before the age of 11
Your chances of getting adenomyosis may increase if:
• You began your periods at younger than 10
• You have shorter menstrual cycles (24 days or less)
• You’re in your 40s / older
How are they both diagnosed?
Endometriosis and adenomyosis can be tricky to diagnose, this is why so many women go undiagnosed for years. You may have one or the other, or even both. The symptoms overlap with other conditions including pelvic floor issues, IBS and fibroids or cysts.
Ultrasound can potentially pick up endometriosis, and while an MRI can prove successful, it may miss the smaller patches of endometrial tissue. The surefire way to rule out or diagnose endometriosis is through keyhole surgery. This enables your doctor to locate any endometrial tissue within the stomach. If they catch any, small pieces can be sent to a lab to confirm/rule out endometriosis.
With adenomyosis, an ultrasound or MRI may not suffice— you may need to opt for a hysterectomy, allowing for your uterine tissue to be tested in a lab.
How are endometriosis and adenomyosis treated?
Unless your symptoms are debilitating or affecting your quality of life, treatment may not be necessary. Pain can be managed for both with pain medication and for some, hormone medication such as birth control, progestin and progesterone can be effective.
These manipulate the hormone cycle and can help slow down the growth of endometrial tissue. It’s important to note however that these routes will not make the growth disappear or stop.
The heavy bleeding caused by adenomyosis can be offset with an IUD, or some may opt for uterine artery embolisation— a procedure to block the flow of blood to the uterus. However, the only confirmed cure as of now is a hysterectomy (removal of the uterus). Before opting for this route, it’s important to question whether pregnancy is in your future plans.
Surgery can be a choice for endometriosis— by removing tissue outside of the uterus. If pregnancy isn’t something the person wishes, they can also opt for a hysterectomy. However, it must be noted that there is a small possibility of the pain coming back despite opting for a hysterectomy.
It’s vital that you discuss your options with your gynaecologist and doctor, to ensure that you are making the right choice or you and the level of discomfort you are living with.
BBC's Naga Munchetty on living with adenomyosis
When speaking on her BBC Radio 5 Live show, the BBC's Naga Munchetty has shared more about her experience of adenomyosis including her agonising wait for answers and a treatment.
"Right now as I sit here talking to you: I am in pain. Constant, nagging pain. In my uterus. Around my pelvis. Sometimes it runs down my thighs. And I'll have some level of pain for the entire show and for the rest of the day until I go to sleep."
A recent flare-up was so bad Naga's husband called an ambulance. "The pain was so terrible I couldn't move, turn over, sit up. I screamed non-stop for 45 minutes", she told listeners.
About the expert
Dr. Amit Shah is a leading gynaecologist and co-founder of Fertility Plus. He's been a member of the Royal College of Obstetricians and Gynaecologists since 2004 and has previously practised as a Consultant and Clinical Lead at the Homerton Fertility Centre where he established one of the most successful IVF clinics, providing excellent patient care alongside a first-class junior doctor training programme. After 25 years of commitment to the NHS, Mr Shah now works exclusively privately and remains involved with research and development of science. Mr Shah trained as a fertility specialist in India, as well as the UK, and has since practised in the USA, Germany and the UK. He has a major interest in treating egg donor IVF, surrogacy and sperm donation treatments in addition to fertility treatments and fertility-preserving surgeries, including treatment of endometriosis and assisted conception and egg freezing.