Adenomyosis: a common cause of heavy, painful periods with no cure short of surgery

Adenomyosis — where the tissue that lines the womb grows into its muscular wall — is a common but under-recognised cause of heavy, painful periods, and the only definitive cure is removing the uterus [s1]. In one prospective study, transvaginal ultrasound found signs of it in 206 of 985 women (20.9%, 95% confidence interval 18.5% to 23.6%) attending a general gynaecology clinic — a long way from the rare, late-life condition it was once assumed to be [s2].

That gap between the old picture and the new one is the reason so many women wait years for the name of what is wrong with them.

A diagnosis that used to require a hysterectomy

For decades adenomyosis was framed as the classic condition of multiparous women over 40 who had pain and heavy menstrual bleeding, and it was typically confirmed only by examining the uterus after hysterectomy [s1]. Because the evidence came almost entirely from removed uteruses, older prevalence figures were skewed toward women sick enough to need surgery.

Imaging changed that. Adenomyosis is now increasingly identified in younger women — some with pain, abnormal uterine bleeding or infertility, and some with no symptoms at all — using transvaginal ultrasound and magnetic resonance imaging rather than a pathology report [s1]. The prospective clinic study that put the figure near one in five did exactly this, recording standardised ultrasound features in 985 consecutive attendees; the likelihood of finding adenomyosis rose with a woman's age and number of pregnancies and with coexisting pelvic endometriosis [s2].

It now sits formally among the causes of abnormal uterine bleeding, as the "A" in the international PALM-COEIN classification used to categorise them [s1].

Why it is still hard to pin down

The catch is that the field has not agreed on how to define the disease. There is no consensus on the definition and classification of adenomyotic lesions, from either the pathology or the imaging point of view, so the diagnosis remains difficult and, at the margins, subjective [s1]. Two clinicians looking at the same scan can reasonably disagree, and a uniform reporting system is still being called for so that imaging features can be tied reliably to symptoms and to treatment response [s1].

Adenomyosis also rarely travels alone. It frequently coexists with endometriosis and uterine fibroids, which muddies both research data and the job of working out which condition is driving a given woman's pain or bleeding [s1].

What treatment can and cannot do

The honest framing is the one the evidence supports: short of hysterectomy, treatment manages the disease rather than ending it, and it requires a lifelong plan because adenomyosis has a lasting effect on quality of life through menstrual symptoms, fertility and pregnancy [s1]. Hormonal options aim to suppress the bleeding and pain; surgery removes the uterus and with it the disease.

Between those poles sits a uterus-preserving procedure for women who want to avoid hysterectomy. Uterine artery embolization, which blocks the blood supply to the affected tissue, was assessed in a systematic review of 22 studies covering 1,701 patients treated for therapy-resistant adenomyosis [s3]. Significant improvement in heavy bleeding, period pain and bulk-related symptoms was reported in 1,301 of the 1,701 patients (76.4%) at short- and mid-term follow-up, with reductions in uterine volume, low reintervention and hysterectomy rates, mostly minor complications and a post-procedure mortality rate of 0% [s3]. The reviewers positioned it as a step on the treatment pathway before hysterectomy rather than a cure, and said women should be able to consult an interventional radiologist when weighing their options [s3].

The fertility dimension

For women trying to conceive, adenomyosis is not a neutral finding. It carries a negative impact on fertility and pregnancy outcome and a raised risk of miscarriage and obstetric complications [s1], which is part of why identifying it in younger women — rather than only at hysterectomy decades later — matters clinically as well as for symptom relief.

What it means for patients

The practical takeaway is about recognition. A condition present in roughly a fifth of women in a gynaecology clinic [s2], capable of causing years of heavy, disabling periods, is still routinely missed or mislabelled because its definition is unsettled and its main symptoms overlap with more familiar diagnoses. Better and more consistent imaging is the near-term lever, not a new cure.

This article describes what the research and reviews report and is not medical advice; decisions about investigating or treating heavy or painful periods belong with a clinician who knows the individual case.

Sources

• Recent advances in understanding and managing adenomyosis — F1000Research, 2019-03-13
• How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic — Human Reproduction, 2012-10-18
• Uterine artery embolization for the treatment of symptomatic adenomyosis: a systematic review — CVIR Endovascular, 2026-07-15