Adenomyosis and endometriosis: What’s the difference?

You might have heard of endometriosis, but what about adenomyosis? Here we take a look at both conditions, along with their symptoms, causes, and treatment options.

Key takeaways

• Adenomyosis is a condition where the tissue that usually lines the uterus (endometrium) grows into the muscle layer of the uterus. Endometriosis is when tissue similar to the endometrium grows outside of the uterus. 
• Both adenomyosis and endometriosis can cause painful and heavy periods, pelvic pain, and pain when having sex. 
• The exact cause of adenomyosis and endometriosis is still unknown, which makes both difficult to diagnose.
• Treatment for both adenomyosis and endometriosis includes hormonal birth control, pain medications, and sometimes surgery.

What are the similarities and differences between adenomyosis and endometriosis? 

First things first: What exactly are endometriosis and adenomyosis? To explain the conditions, we need to do a quick biology lesson. Your uterus has a layer of tissue called endometrium. During your menstrual cycle, hormones cause this layer to build up to support a possible pregnancy. If you don’t get pregnant, the layer will shed. This is your period.  

If you have endometriosis, tissue similar to the endometrium grows outside of your uterus, often affecting your reproductive organs such as your ovaries and uterine tubes. It could even grow in areas such as your bladder, bowels, rectum, or more rarely, your lungs, diaphragm, and kidneys. Just like the endometrium in your uterus, this tissue is also affected by your hormones, meaning it grows and bleeds throughout your cycle. This can lead to the surrounding tissue becoming inflamed, which can cause issues such as ovarian cysts, adhesions, and scar tissue.

Adenomyosis is a condition where the tissue that usually lines your uterus (endometrium) grows into the muscle layer of the uterus, causing it to double or triple in size. The exact cause isn’t known, although risk factors include being aged 35 to 50, prior childbirth, and having uterine surgery, such as a cesarean section. 

Symptoms

Although they’re two different conditions, adenomyosis and endometriosis share symptoms such as painful and heavy periods. Both adenomyosis and endometriosis can also cause issues with fertility.

Endometriosis 

Endometriosis symptoms can include the following: 

• Painful, heavy, or irregular periods
• Pain during or after sex
• Spotting or bleeding between periods
• Difficulty conceiving or infertility
• Pain when peeing or pooping 
• Fatigue
• Diarrhea or constipation during your period 

It’s worth noting that these symptoms can affect everyone differently, so you might experience some, all, or none of the symptoms above to a different extent. Having more severe symptoms does not necessarily mean you have a more severe form of endometriosis.

Adenomyosis 

Adenomyosis symptoms can include the following: 

• Heavy periods
• Pain during sex
• Pain in your pelvis
• Severe cramping or a sharp pain in your pelvis during your period
• Problems conceiving or infertility

Risk factors

Endometriosis

Some factors that may increase your risk of endometriosis include: 

• Starting your period for the first time before the age of 11
• Having short menstrual cycles (less than 27 days long)
• Having heavy periods that last for more than seven days
• Having a close relative, such as a mother or sister, with the condition
• Having an abnormal uterus (this would only be diagnosed by a doctor)

Adenomyosis 

Factors that may increase your risk of adenomyosis include:

• Giving birth
• Being middle aged 
• Having had previous surgeries on your uterus, such as a C-section or fibroid removal

Causes

Endometriosis

Exactly what causes endometriosis isn’t clear, so there is no known cause. However, there are some theories.

One of these is retrograde menstruation. This is when period blood flows upward through your uterine tubes instead of leaving your body through your vagina. This is normal, but researchers believe this can lead to endometrial cells sticking to your pelvis and other body parts, causing endometriosis. 

There could also be a genetic component to endometriosis. This means that if you have a family history of the condition, you could be at an increased risk of developing it yourself. If you have any concerns, be sure to reach out to your health care provider for advice.

Adenomyosis

The cause of adenomyosis is also still unknown, but again, experts have a few theories. One suggests that during surgeries that affect the uterus, such as C-sections, cells from the uterine lining may enter the muscles of the uterus wall. 

Some experts also believe that after childbirth, inflammation of the uterine lining may disturb the normal boundary of cells that line the uterus, causing adenomyosis. As with endometriosis, more research is needed to determine the actual cause.

How common are they? 

It’s estimated that endometriosis affects around 1 in 10 women of reproductive age, and it’s most often diagnosed in women in their 30s or 40s. There aren’t any specific statistics on how common adenomyosis is, but it’s more likely to be diagnosed in women over 40 or women who have had surgery on their uterus.

However, diagnosing adenomyosis or endometriosis isn’t straightforward, so they could be more common than we think. Because they share symptoms, they’re often mistaken for one another. It’s also possible to have both adenomyosis and endometriosis at the same time. 

How are adenomyosis and endometriosis diagnosed?

Endometriosis

If you think you might have endometriosis, the first step would be for your doctor to perform a physical exam, which will include a pelvic exam. However, this can be inconclusive, so they may recommend a procedure called a laparoscopy.

During a laparoscopy, a surgeon makes a small incision in your abdomen and inserts a thin tube with a light and camera to look for — and potentially remove — any endometrial lesions or adhesions. This is the surest way to diagnose endometriosis.

Frustratingly, diagnosing endometriosis can take a long time — sometimes up to 12 years.

Adenomyosis

Adenomyosis can be tricky to diagnose because it can cause many symptoms. Sometimes, these symptoms can be confused with other conditions, like endometriosis, fibroid tumors, or growths in the endometrial lining.

If you think you have adenomyosis, the diagnosis may also involve a pelvic exam. Your doctor may also suggest an ultrasound or magnetic resonance imaging (MRI) to take a look at your uterus. 

Does the treatment differ for endometriosis and adenomyosis?

Although the recommended treatments for the two conditions are the same, they mainly depend on the type and severity of your symptoms. Treatments include oral contraceptives, pain medication, and surgery. Your doctor will also take into consideration whether or not you want to have children in the future before recommending a treatment plan. That’s because some of the treatment methods can affect your fertility.

Endometriosis 

There’s no cure for endometriosis (yet), but there are ways to manage it and improve your quality of life. Common treatments for endometriosis include the following: 

• Hormonal birth control, such as the combined pill, progestogen-only pill, or hormonal intrauterine device (IUD), can help to slow down how quickly the endometrial tissue grows while preventing new adhesions from forming.
• Painkillers and anti-inflammatory medication can help manage the pain.
• Surgery — usually a laparoscopy, although sometimes a laparotomy (a more invasive procedure) or, in severe cases, a hysterectomy (surgical removal of the uterus and uterine tubes) — may be recommended. 

It’s important to remember that surgery may not always provide permanent pain relief, and there’s no one-size-fits-all solution. Your doctor can help you determine the best time for surgery based on the severity of your condition and your individual needs. 

Adenomyosis 

Similarly to endometriosis, there is no known cure for adenomyosis. However, there are some treatment options that can help. These include the following: 

• Hormonal birth control, such as the combined pill, progestogen-only pill, or hormonal IUD, can help to slow down how quickly the endometrial tissue grows while preventing new adhesions from forming.
• Painkillers and anti-inflammatory medication, like ibuprofen, can help manage the pain.
• Tranexamic acid, a nonhormonal medication, can reduce heavy periods. It comes in pill form and is taken only during your period. It might be a helpful solution if you can’t take hormonal birth control and don’t want to have surgery.
• Hysterectomy is the surgical removal of the uterus and uterine tubes. This option is usually only offered if there are no improvements from other treatments.

Tips on living with endometriosis or adenomyosis

Living with endometriosis or adenomyosis can be really tough, and although some people don’t have any symptoms, for others, it can seriously impact their quality of life. If you’re struggling, rest assured that there are some things you can do to help relieve your symptoms. Here are some lifestyle tips on living with endometriosis or adenomyosis: 

• Stay active. One study found that women with endometriosis who exercised three days a week reported lower pain levels afterward, although more research is needed to be clear on this link. And while you might not want to exercise if your endometriosis or adenomyosis is flaring up and causing pain, staying active can help your overall health. So, try to fit in some exercise and consider low-impact options like a walk or gentle yoga. 
• Get enough sleep. Endometriosis can cause fatigue, so try to prioritize sleep and rest when you can. 
• Track your period. By tracking your period and symptoms each month with an app like Flo, you can anticipate when you may experience the most pain. Clear your schedule during those times to take it easy and focus on self-care.
• Join a support group. There are online resources and support groups where you can connect with others who have endometriosis and adenomyosis. You can also ask your health care provider about local groups if you want to meet in person.