Adenomyosis vs. Endometriosis: What’s the Difference?

For many women, experiencing pelvic pain, heavy menstrual bleeding, and discomfort during intercourse can be a distressing part of life. Two conditions that are commonly associated with these symptoms are adenomyosis and endometriosis. Though both conditions involve abnormal growth of tissue in or around the uterus, they have distinct characteristics and treatment approaches. In this blog, we will dive into the differences between adenomyosis and endometriosis, their symptoms, causes, and treatment options, so you can better understand these conditions.

What Is Adenomyosis?

Adenomyosis occurs when tissue that typically lines the inside of the uterus (the endometrium) grows into the muscular walls of the uterus (the myometrium). This results in an enlarged uterus and can lead to various symptoms like heavy menstrual bleeding, pelvic pain, and an enlarged abdomen.

Some common symptoms of adenomyosis include:

• Heavy menstrual bleeding or long periods
• Pelvic pain, which may increase during menstruation
• Painful intercourse or discomfort during sexual activity
• Enlarged uterus, often felt during a pelvic exam
• Bloating and a feeling of fullness in the abdomen

The exact cause of adenomyosis is still unknown, though it may be linked to factors like hormonal imbalances, previous uterine surgeries, or childbirth.

What Is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, typically on the ovaries, fallopian tubes, or the outer surface of the uterus. This tissue responds to hormonal changes during the menstrual cycle, thickening, breaking down, and bleeding. However, because this tissue has no way to exit the body, it can cause inflammation, scar tissue, and adhesions, leading to severe pain and fertility problems.

Some of the main symptoms of endometriosis include:

• Severe pelvic pain, especially during menstruation
• Heavy or irregular periods
• Pain during intercourse
• Pain with bowel movements or urination during menstruation
• Infertility or difficulty getting pregnant
• Fatigue, nausea, and bloating

Endometriosis can range from mild to severe, and it can significantly impact a woman’s quality of life.

Key Differences Between Adenomyosis and Endometriosis

While both adenomyosis and endometriosis involve abnormal growth of endometrial tissue, the primary difference lies in where the tissue grows.

1. Location of the Tissue

• Adenomyosis: The endometrial tissue grows inside the muscular walls of the uterus.
• Endometriosis: The endometrial-like tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, or the outer surface of the uterus.

2. Symptom Severity

• Adenomyosis: Symptoms are typically less severe compared to endometriosis but can still include heavy bleeding, pelvic pain, and abdominal bloating. In some cases, the symptoms may worsen as the condition progresses.
• Endometriosis: The symptoms of endometriosis can be quite severe, with women experiencing debilitating pain, especially during menstruation. It can also lead to fertility issues, which is not a typical symptom of adenomyosis.

3. Fertility Implications

• Adenomyosis: While adenomyosis can affect fertility, it typically does not cause infertility directly. However, some women with adenomyosis may have difficulty conceiving, especially if the condition leads to an enlarged uterus or scarring.
• Endometriosis: One of the most common complications of endometriosis is infertility. The adhesions and scar tissue that form due to the growth of endometrial-like tissue outside the uterus can obstruct the fallopian tubes and interfere with egg release, making it harder to conceive.

4. Diagnosis

• Adenomyosis: Diagnosis of adenomyosis often involves imaging techniques such as ultrasound or MRI, and it can sometimes be confirmed only after surgery. A pelvic exam may reveal an enlarged uterus.
• Endometriosis: Endometriosis is typically diagnosed via laparoscopy, a minimally invasive surgical procedure that allows the doctor to examine the pelvic organs and remove or biopsy the abnormal tissue.

5. Causes and Risk Factors

• Adenomyosis: The exact cause is unclear, but adenomyosis is thought to be linked to previous uterine surgeries, like C-sections or fibroid removal, and childbirth. Hormonal imbalances, especially estrogen, may also play a role.
• Endometriosis: The cause of endometriosis is also unknown, but several factors, including genetics, immune system issues, and retrograde menstruation (when menstrual blood flows backward into the pelvic cavity), may contribute to the condition.

Treatment Options for Adenomyosis

Though there is no cure for adenomyosis, several treatments can help manage symptoms, especially for women who wish to preserve their fertility.

1. Hormonal Therapy

Hormonal treatments, such as birth control pills, IUDs, or hormone injections, can help regulate the menstrual cycle and reduce heavy bleeding. These treatments work by controlling the growth of endometrial tissue and providing pain relief.

2. Uterine Artery Embolization (UAE)

This minimally invasive procedure blocks the blood vessels supplying the uterus, which can shrink fibroids and adenomyosis tissue, thus reducing symptoms.

3. Endometrial Ablation

This treatment destroys the lining of the uterus, which can help reduce heavy bleeding caused by adenomyosis. However, it is not suitable for women who wish to have children in the future.

4. Hysterectomy

For women who no longer wish to have children and have not found relief through other treatments, a hysterectomy (removal of the uterus) may be the most effective treatment. This procedure eliminates adenomyosis but is typically considered a last resort.

Treatment Options for Endometriosis

Endometriosis can be treated with a combination of medications and surgery, depending on the severity of the condition.

1. Pain Management

Over-the-counter pain relievers, such as ibuprofen, can help manage the pain associated with endometriosis. Prescription pain medications or stronger drugs, like opioids, may be prescribed for more severe cases.

2. Hormonal Therapy

Similar to adenomyosis, hormonal treatments like birth control pills, IUDs, and GnRH agonists are commonly used to control the growth of endometriosis tissue and manage pain.

3. Surgical Treatment

In more severe cases, surgery may be required to remove endometrial tissue and adhesions. Laparoscopic surgery can be used to treat endometriosis while preserving the ovaries and uterus, which is ideal for women who wish to preserve fertility.

4. Fertility Treatment

For women experiencing infertility due to endometriosis, assisted reproductive technologies, such as in vitro fertilization (IVF), may be considered.

When to Seek Medical Advice

If you are experiencing symptoms like pelvic pain, heavy periods, or difficulty conceiving, it is important to seek medical advice to determine whether adenomyosis or endometriosis may be the cause. Early diagnosis can help manage the condition effectively and improve your quality of life.

Conclusion

Although adenomyosis and endometriosis share some similar symptoms, they are distinct conditions that require different treatment approaches. Understanding the differences between these two conditions is essential for women who are seeking relief from pelvic pain, heavy bleeding, and fertility concerns. If you suspect you have either of these conditions, reach out to a healthcare provider for a thorough examination and personalized treatment plan.

Dr. Sunita Arora is here to support you every step of the way. Book your consultation today and take the first step toward effective management of adenomyosis or endometriosis.