Adenomyosis vs Endometriosis, what is the difference?
Adenomyosis is a disease of the uterus with similarities to Endometriosis. Both conditions are common; less is known of the prevalence of Adenomyosis, however, as it has been less extensively studied compared with its sister condition, Endometriosis.

Adenomyosis vs Endometriosis are actually the same disease, with the same histology make up. The difference between the two lies in where the endometrial tissue grows and which pelvic organs it affects.

Endometriosis occurs when tissue similar to that found inside the uterus grows outside of the uterine cavity. Endometrial-like tissue growth can be found on other pelvic organs, such as the bladder, bowel, fallopian tubes or ovaries.

Adenomyosis involves the presence of endometrial tissue which grows into the muscular wall of the uterus.

Despite what you might have read, neither adenomyosis nor endometriosis is a cancerous condition.

Related reading: Adenomyosis – Why Heavy Periods Are Not Normal.

Can endometriosis be mistaken for adenomyosis?

These conditions can have similar symptoms; therefore, unfortunately, it’s common for both conditions to be misdiagnosed or mistaken for each other.

The symptoms of both conditions can be associated with other health problems, making diagnosing adenomyosis or endometriosis difficult. If you think you might have symptoms of either, it’s important to speak to your healthcare provider, who will refer you to a women’s health specialist for further tests.

For more on endometriosis read our article Endometriosis Stages | 4 Critical Stages.

Adenomyosis vs Endometriosis: Symptoms

As with many other conditions, there can be a wide spectrum of symptoms. Some women might not experience any; one third of those with adenomyosis have no symptoms at all. Unfortunately, however, many women can experience quite severe symptoms with both conditions.

Adenomyosis symptoms tend to revolve around period-related pain – for example, painful periods or heavy menstrual bleeding. Endometriosis pain can be experienced during other times in the menstrual cycle or can be pain associated with sex or having a bowel movement.

Common symptoms include:

Heavy menstrual bleeding/excessive bleeding
Prolonged painful periods
Chronic pelvic pain
Painful sexual intercourse
Loose bowel movements
Painful bowel movements
Feeling of pressure in the tummy
Bloating
Enlarged uterus
Back pain
Irritable bowel or urinary tract symptoms
Mental/emotional disturbances
Reduced quality of life.

Related reading: Painful Sex After C-Section | What Causes It?

Adenomyosis vs Endometriosis: Complications

In both adenomyosis and endometriosis, the endometrial tissue cells behave in the same way as they would do ordinarily during the menstrual cycle: they thicken, break down and shed. But instead of being expelled via the vaginal canal during a period, they have no way to escape and remained trapped in the body. The misplaced tissue can shed blood into the pelvic cavity, causing inflammation, cysts, adhesions and scar tissue to form over time.

Neither endometriosis nor adenomyosis is a life threatening condition, but both can have a significant impact on your everyday activities and lifestyle – particularly if symptoms are severe. Unfortunately, symptoms often become worse over time and both conditions can also lead to further complications.

Some of them are:

Anemia

Heavy menstrual periods as a result of adenomyosis and endometriosis are one of the biggest causes of iron deficiency anemia. Heavy bleeding leading to anemia also increases the chances of requiring iron supplementation or iron transfusions.

For more information read our article Heavy Periods After Childbirth | 4 Important Reasons Why.

Impaired fertility and pregnancy loss

Conceiving can difficult with both conditions. Scar tissue on the ovaries or Fallopian tubes can obstruct either the journey of the egg to the uterus or the journey of the sperm to the egg. This can make the chances of conceiving each month much lower.

It also increases the risk of ectopic pregnancy, where an embryo develops and grows outside of the uterus, commonly in the Fallopian tube. It’s impossible for a pregnancy to continue to develop there and ectopic pregnancy can also be life-threatening to the mother.

There’s also an increased risk of miscarriage or pregnancy loss as the embryo can struggle to implant into the wall of the enlarged uterus. The condition of the uterine tissues might not be sufficient to fully nourish a growing embryo. Increased inflammation, due to abnormal hormonal fluctuations, might also make it more difficult to carry a baby to full term, therefore increasing the risk of preterm birth.

Related reading: Preterm Birth | Ways To Reduce Preterm Birth.

Many women with adenomyosis can also suffer from endometriosis, uterine fibroids or polyps, which can also affect fertility.

Due to the association between the two conditions and impaired fertility, it’s common for those with endometriosis or adenomyosis to receive IVF or fertility treatment.

More research is needed into the extent of the effect of adenomyosis on fertility. Data suggests that adenomyosis has an unfavorable effect on IVF treatment. A study concluded that rates of miscarriage were higher and that the rates of pregnancy per cycle and per embryo transfer, successful embryo implantation, continuing pregnancy and live birth were all markedly lower in women who had the condition, compared with those who didn’t, even after taking into account compounding factors, such as age.

If you know someone going through IVF read our article 10 Ways To Support A Friend Going through IVF.

Risk factors for Adenomyosis

Adenomyosis was once regarded as a condition more commonly seen in women over 40. More recently, however, the condition has increasingly been diagnosed in asymptomatic younger women of reproductive age. Approximately 20% of cases of adenomyosis involve women younger than 40 and 80% are aged 40 to 50.

Adenomyosis is also more common in women who:

Have had prior uterine surgery, such as c-section, fibroid removal or dilatation and curettage (D&C)
Have given birth at least once
Have endometriosis
Have retrograde menstruation, where blood from periods flows backwards through the fallopian tubes and into the abdomen
Effects fertility.

Risk factors for Endometriosis

Endometriosis is more common in women who:

Have a family history of endometriosis
Started their periods before the age of 11
Have menstrual cycles lasting less than 27 days
Have heavy periods lasting more than 7 days.
Effects fertility.

What causes Adenomyosis to grow?

The exact causes for the condition require further research; however, experts have a few theories as to why some women might develop the condition:

Cell invasion. Endometrial cells from the uterine tissue invade the muscle cells layers. Incisions from surgery, such as cesarean section, might promote the invasion of these cells in the muscle layer of the uterus
Developmental causes. Endometrial tissue is deposited into the muscle layer of the uterus when the organ is first formed
Uterine inflammation. There’s a link between adenomyosis and childbirth. It’s thought that during the postnatal period inflammation in the uterus could cause a breakdown in the lining, increasing the chances of adenomyosis
Stem cell origins. Bone marrow stem cells might invade the uterine lining and muscle.

The growth of adenomyosis depends on the body’s circulating level of estrogen, which might explain why more cases are found in women over the age of 40, as they have had a greater exposure to the hormone, compared with younger women.

Adenomyosis vs Endometriosis: Diagnosis

People with symptoms of heavy bleeding during their menstrual flow, painful intercourse, chronic pain or painful periods tend to visit their GP or doctor for further assessment and investigation.

After a full medical history and an understanding of the nature of your symptoms, the next step is a pelvic exam. Your doctor will palpate your abdomen and perform an internal exam to check your vulva, vagina and cervix, to assess for any potential abnormalities, such as cysts or fibroids and to try to find a cause for the symptoms.

Most likely, further investigations and a diagnostic test will be required, to rule out anything more serious.

Further tests might include:

Abdominal/transvaginal ultrasound. This might detect the presence of cysts or fibroids which could be associated with endometriosis
Magnetic resonance imaging scans (MRI). These scans can give detailed images of the tissues and organs in your body
Laparoscopy. In some cases, your doctor might refer you for laparoscopic surgery, where a small camera is used to take a detailed look inside the abdomen. A laparoscopy can detect endometrial tissue outside the uterus, which could be the cause of pelvic pain
Tissue biopsy. During a laparoscopy, your surgeon might wish to take a tissue sample.

Following these investigations, your doctor might be able to diagnose endometriosis. The only definitive way to diagnose adenomyosis, however, is to examine the uterus after a hysterectomy.

Does Adenomyosis cause belly fat?

Adenomyosis doesn’t directly cause you to gain weight; however, it’s common for the condition to enlarge the uterus. This can make your belly protrude more than normal, causing the abdomen to look distended. The uterine wall can become thickened, due to the normal shedding of the tissue that lines the uterus, causing it to push into the uterine muscle layer. This can build up and lead to the development of fibroids, which thicken the wall of the uterus. This distended appearance is sometimes nicknamed ‘adenomyosis belly’. In some cases, women can look 3-6 months pregnant, due to the enlarged uterus. It can become frustrating if you are unable to fit in to your normal clothes.

Secondary to the enlarged uterus, another of the side effects of adenomyosis is fatigue. A lack of energy can make you feel unmotivated or unable to engage in physical activity. You might also gain weight, due to a reduction in normal activity levels.

Adenomyosis vs Endometriosis: Treatment

Options for treating adenomyosis will vary from person to person, depending on the severity of symptoms and other considerations, such as family planning choices. Most cases of adenomyosis will resolve after menopause; therefore, the course of treatment might depend on your age and how close you are to menopause.

See your healthcare provider and discuss which option might be the best for your situation. Some common treatments are:

Anti inflammatory medications. Pain medications, such as ibuprofen (Advil, Motrin etc) can relieve pain but also help to reduce bleeding during periods
Hormonal treatments. Oral contraceptives have long been used to manage period-related symptoms, such as heavy bleeding, cramps and bloating and to even out hormone levels
Hysterectomy. More invasive treatments, such as hysterectomy, might be considered in extreme cases or as a last resort to manage adenomyosis.

If you are considering a hysterectomy, read our article by Dr Andrew Orr Is Hysterectomy Necessary To Fix Endometriosis?

What happens if Adenomyosis is left untreated?

If left untreated, the condition will not resolve on its own. Typically, symptoms tend to remain the same or to become worse over time. Even so, you don’t need to suffer in silence. Although the condition will not go away completely, it can be managed successfully with the right care, treatment and support.

Living with Endometriosis and Adenomyosis

Both conditions can have a serious impact on your lifestyle, depending on the severity of symptoms and how well they are managed. The effects of both are not just related to the physical body but can also have an impact on your emotional well being.

Some women might be able to manage the condition with simple at-home comfort measures, such as warm baths and heat pads, or over the counter medications. Some individuals might require interventional alternatives, such as hormonal contraceptives that can stop periods or minimize the symptoms related to them.

Don’t be afraid to reach out to loved ones or friends for emotional support, or to your healthcare provider for the support that you need.