What is Adenomyosis?
Adenomyosis occurs when endometrial tissue, which normally lines the uterus, grows into the muscular wall (myometrium). The displaced tissue still responds to the menstrual cycle, causing the uterine wall to thicken, often leading to heavy, painful periods, an enlarged uterus and chronic pelvic pain. It is most common in women in their 30s and 40s and frequently coexists with endometriosis or fibroids.
How Adenomyosis Affects Fertility
Distorted uterine cavity may interfere with embryo implantation
Altered uterine muscle contractions can disrupt sperm transport and implantation
Inflammation in the uterus can affect egg quality and embryo development
Associated with higher rates of miscarriage and preterm birth
Often coexists with endometriosis, compounding the impact
Many women still conceive — the impact varies considerably
Diagnosis and Treatment Options
Diagnosis: transvaginal ultrasound or MRI is typically used; MRI is more accurate
Pain management: NSAIDs, hormonal contraceptives or a Mirena coil (if not trying to conceive)
GnRH agonists temporarily shrink adenomyotic tissue and can improve IVF outcomes
IVF is often recommended, sometimes with a "long protocol" of pre-treatment to suppress the disease
Surgery to remove adenomyosis (adenomyomectomy) is complex and reserved for selected cases
Hysterectomy is the only definitive cure but ends fertility, so it is a last resort