By: Kathy Hubbard
There’s a big difference between having monthly cramps and having severe monthly cramps, just like there’s a big difference between heavy bleeding and bleeding so badly you develop anemia. There’s also a difference between having adenomyosis, endometriosis or fibroids, although there is a possibility that one may have all three.
“Adenomyosis (add-en-o-my-OH-sis) is a condition that affects the uterus. The uterus is the hollow, pear-shaped organ where a baby grows during pregnancy. When you have adenomyosis, the tissue that lines the inside of the uterus grows into the muscle wall of the uterus. This tissue is called endometrial tissue,” Mayo Clinic explains.
So, what’s the difference between adenomyosis, endometriosis and fibroids? It all comes down to where the tissue grows. Adenomyosis grows inside the uterus, as just explained; endometriosis grows outside and can affect other organs; fibroids are caused by benign tumors (solid masses of cells).
Today, we’re focusing on adenomyosis. The National Institutes on Health says that the exact number of women affected is unknown because many do not suffer from symptoms. However, it’s estimated that the condition can affect anywhere from one in ten to one in five “individuals with a uterus.”
Cleveland Clinic estimates that two to five percent of adolescents with severely painful cycles have adenomyosis. Other symptoms besides cramps and heavy menstrual bleeding are abnormal menstruation, pelvic pain with or without severe cramping, painful intercourse, infertility, enlarged uterus, bloating or fullness in the belly. They also say that symptoms tend to get worse over time.
“Researchers don’t know why some people develop adenomyosis or what causes it,” Cleveland says. “However, some research suggests hormones, genetics, inflammation or trauma may contribute to adenomyosis.”
They say that adenomyosis mostly occurs in women who are between the ages of 40 and 50; have given birth at least once; have had prior uterine surgeries, such as uterine fibroid removal, caesarean section, or dilation and curettage (D&C), and/or have endometriosis. But the alarms are going off because providers are diagnosing it far more frequently in women in their thirties who have abnormal bleeding or painful periods.
Excessive menstrual bleeding can lead to anemia which develops when blood loss results in too few red blood cells in the body, so tissues don’t receive enough oxygen. Johns Hopkins Medicine says, “Anemia can lead to fatigue, dizziness, fainting, lightheadedness and shortness of breath. Some women go the emergency room for heavy bleeding during menstrual periods and need a blood transfusion.”
They also say that researching “the effect of adenomyosis on pregnancy or fertility is ongoing. Early studies suggest that it could affect a woman’s ability to get pregnant, especially those undergoing in vitro fertilization.
The first step in diagnosing adenomyosis is a pelvic exam. Cleveland Clinic explains that during the exam “your provider may notice that your uterus has gotten larger, softer or is painful to the touch.”
The PCP then, may order an ultrasound which may show the thickening of the uterine wall, and/or an MRI which “can show uterine enlargement and thickening of certain areas of your uterus. Your provider may rule out more serious conditions with a biopsy. During a biopsy, your provider collects tissue and tests it for signs of more serious diseases.”
They go on to say that “because the hormone estrogen promotes endometrial tissue growth, adenomyosis symptoms often go away after menopause. In the meantime, treatments can ease pain and help with heavy bleeding and other symptoms.”
These treatments might include nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin), or naproxen (Aleve) to ease cramping, and hormonal and some nonhormonal medications to help with menstruation and abnormal bleeding.
Some women will require an adenomyomectomy. “This surgery removes adenomyosis from your uterine muscle.” And others may require a hysterectomy. “This surgery removes your uterus. After a hysterectomy you won’t have a menstrual cycle or be able to get pregnant,” Cleveland explains.
“Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo can’t implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain.”
As always, if you have any symptoms of adenomyosis, you should contact your primary care provider. If you do not have one, Bonner General Health Family Practice is accepting new patients. Give them a call at 208-265-2221.
Kathy Hubbard was a charter member of Bonner General Health Foundation. She can be reached at [email protected]. This article was written for publication in the Bonner County Daily Bee on October 28, 2026.