Adenomyosis: symptoms, diagnosis and care

When to seek help sooner

Go to an emergency department for severe pelvic or abdominal pain, whether it starts suddenly or builds up. Call 000 if you collapse, feel faint with severe pain or bleeding, or need an ambulance. Do not assume new or much worse symptoms are caused by adenomyosis, or wait for a routine telehealth appointment.

Seek urgent medical attention if pain comes with fever, persistent vomiting or a swollen abdomen. Healthdirect explains when abdominal pain needs urgent care.

If pregnancy is possible and you have pelvic pain, seek prompt medical assessment. Pain with vaginal bleeding, shoulder-tip pain, dizziness or faintness can indicate an ectopic pregnancy: go to an emergency department now. Read about ectopic pregnancy symptoms.

What symptoms can adenomyosis cause?

Symptoms can include heavy or prolonged periods, painful periods, ongoing pelvic pain, and pain during sex. Their impact varies: some people have little discomfort, while others find work, sleep or everyday activities difficult.

These symptoms can have other causes. Bleeding between periods or after sex should also be assessed rather than attributed to adenomyosis. The NHS explains symptoms and overlapping conditions.

Heavy bleeding can lead to iron deficiency or anaemia. Tell your GP if you are also feeling unusually tired or short of breath. Healthdirect explains the effects of heavy periods.

Is it the same as endometriosis?

No. Adenomyosis affects the muscle wall of the uterus. Endometriosis involves tissue similar to the womb lining elsewhere, usually in the pelvis. You can have both, and their symptoms can overlap. Knowing which conditions may be contributing helps guide treatment. RANZCOG explains the distinction.

How can telehealth help?

Telehealth can be useful for an initial appointment about symptoms and for ongoing care. A doctor can discuss your bleeding and pain, review previous results and treatments, discuss treatment options and prescribe when clinically appropriate. Where appropriate, they can arrange tests or referrals and review treatment, side effects and progress at follow-up appointments.

A telehealth doctor cannot perform a physical examination. Whether you need one depends on your symptoms, history and previous assessments. If an examination is needed, the doctor can help arrange appropriate in-person care; it is not required at every appointment. Blood tests and scans also take place through local providers. The Australian Digital Health Agency explains how telehealth and in-person care can work together.

How is adenomyosis assessed?

A GP will ask about bleeding, pain, other symptoms and previous treatment. Depending on your symptoms, they may recommend an in-person examination or a pelvic ultrasound. An internal ultrasound uses a probe placed in the vagina to obtain clearer images of the uterus. Sometimes an MRI or specialist assessment is helpful.

An internal examination or scan needs your consent. You can ask for a chaperone, decline or ask to stop. If you would prefer another approach, discuss the alternatives and their limitations. RCOG explains consent for pelvic examinations.

If bleeding is heavy, blood tests may check for anaemia or low iron. These tests do not diagnose adenomyosis. Healthdirect describes assessment and investigations.

Scans can help identify adenomyosis, but results are interpreted alongside your symptoms. If the result is unclear or symptoms continue, ask what the next step should be. The Australian guideline recommends ultrasound as the first imaging investigation.

What can help?

Treatment depends on your symptoms, health history, preferences and pregnancy plans. Options to discuss include:

• Relief for pain and bleeding: suitable medicines may help. A GP or pharmacist can advise what is safe for you.
• Hormonal treatment: options such as a hormonal intrauterine device (IUD) or some contraceptive pills may reduce bleeding and pain. IUD insertion needs an in-person appointment; telehealth can support the discussion beforehand and follow-up afterwards.
• Comfort measures: a warm pack wrapped in a towel may help with cramps. Avoid direct heat against your skin.

The NHS outlines these treatment options.

Agree on a review date. The Australian guideline suggests reviewing initial treatment at around three months for symptom improvement and side effects. Seek earlier advice if symptoms worsen or treatment causes problems. An ineffective or poorly tolerated treatment can be changed, or specialist advice considered. Read the Australian guideline's adenomyosis recommendations.

Will I need surgery?

Surgery is not inevitable. If symptoms remain difficult despite other treatment, a gynaecologist can discuss whether a procedure is appropriate, its risks and the expected benefit. Hysterectomy removes the uterus and means you cannot carry a pregnancy. It does not guarantee relief from every source of pelvic pain. The Australian guideline discusses treatment choices and uncertainty about pain outcomes.

What if I want to become pregnant?

Tell your clinician if you are trying now or want pregnancy in the future. Adenomyosis can be associated with fertility difficulties, but a diagnosis alone cannot tell you whether you will have trouble conceiving. Some treatments also act as contraception, while procedures can affect future pregnancy options. Discuss a plan that fits your goals. Healthdirect explains why pregnancy plans matter to care.

Preparing for an appointment

If you have previous results or a medicines list, have them available. Mention what bleeding or pain stops you doing and what you have already tried. A few notes about your symptoms can help the discussion.

You might ask: “What else could explain these symptoms?”, “Which options fit my pregnancy plans?” and “When should we review how treatment is working?”

Related HerDoc guides

• Heavy, painful or changing periods — Other reasons for bleeding, pain and cycle changes.
• Endometriosis — Understanding this separate condition, which can occur alongside adenomyosis.