Adenomyosis: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Adenomyosis?
An obstetrician-gynecologist, often called an ob-gyn, usually treats adenomyosis. This is a doctor who specializes in women's health. A gynecologist, a doctor who focuses on the female reproductive system, can run tests and plan treatment. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is adenomyosis?
Adenomyosis happens when tissue like the lining of the uterus grows into the muscle wall of the uterus. The lining is called the endometrium. The muscle wall is called the myometrium. This tissue still responds to hormones each month. It makes the wall thicken and the uterus swell.
Adenomyosis is not cancer. It is benign but chronic, so it can last a long time. It is a common cause of painful periods and heavy menstrual bleeding. Up to a third of women with adenomyosis on ultrasound may have no symptoms at all.
Symptoms
The two most common symptoms are painful periods, also called dysmenorrhea, and heavy menstrual bleeding. Other signs include:
- Bleeding that lasts more than 7 days.
- Cramps that get worse over time.
- Pelvic pain that lasts a long time.
- Pain during sex, also called dyspareunia.
- Blood clots as big as a quarter or larger.
Heavy bleeding can lead to iron-deficiency anemia, which means the body is low on iron from blood loss. Severe anemia can cause shortness of breath and raise the risk of heart problems.
Causes and who gets it
Doctors do not fully understand the cause. The leading idea is that the boundary between the lining and the muscle wall breaks down. Then lining tissue grows down into the muscle. It is seen more often after a D&C (dilation and curettage) or a C-section (cesarean delivery). A second idea is that the tissue forms before birth from stem cells. Stem cells are starter cells that can grow into many types of tissue.
The condition is driven by estrogen, the main female hormone. A first period at an early age, short cycles, higher body weight, and having had several pregnancies all raise risk. Birth control pills and a hormone-blocking medicine called tamoxifen also raise risk. So does prior uterine surgery. It is often found in women ages 35 to 50 who have had at least one pregnancy.
How doctors diagnose it
Doctors start with your history and a pelvic exam. The exam may find a uterus that is enlarged, tender, or boggy, which means soft and swollen. Many women have a normal exam.
Ultrasound is usually the first test. A small probe makes pictures of the uterus. MRI stands for magnetic resonance imaging. It gives clearer pictures when ultrasound is unclear. No blood test can reliably find adenomyosis. The only way to fully confirm it is to check uterine tissue after surgery to remove the uterus.
Treatment
Treatment depends on how bad your symptoms are and whether you want to get pregnant. Most women have some adenomyosis near menopause and do not need treatment.
For pain, doctors often start with NSAIDs. These are drugs like ibuprofen or naproxen that lower swelling and pain. Birth control pills or a levonorgestrel IUD can lighten or stop heavy bleeding. An IUD is a small device placed in the uterus. It releases a hormone. The levonorgestrel IUD is seen as the most effective first hormonal option.
If medicine does not help, there are other options. Uterine artery embolization reduces blood flow to the uterus. Endometrial ablation destroys the lining of the uterus. Ablation works less well for disease deep in the muscle wall. Surgery to cut out the affected tissue keeps the uterus, but the problem can come back. Hysterectomy, surgery to remove the uterus, is the only definitive cure. It is used when other treatments fail or are not an option.
When to see a doctor
Tell your doctor if your periods are heavy or painful. Soaking through one or more tampons or pads every hour for several hours in a row is a sign of heavy bleeding that needs a doctor's review. Severe anemia can cause shortness of breath and raise the risk of heart problems. Call 911 if you have trouble breathing, chest pain, fainting, or bleeding that will not stop.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either doctor can check your symptoms over time and order blood tests for anemia. They can also refer you to a gynecologist for imaging or procedures and help with day-to-day care.
Common questions
Is adenomyosis cancer?
No. Adenomyosis is benign, which means it is not cancer. But it is chronic, and symptoms can go up and down over time.
Can adenomyosis affect my fertility?
The link is not clear. Some studies report an infertility rate of about 11% to 12%. But other data disagree. No cause-and-effect link has been established. Talk with your doctor about your fertility goals when choosing treatment.
Will I need a hysterectomy?
Not always. Doctors usually try medicine first. Hysterectomy is the only definitive cure, and it is used when other treatments fail or are not an option, or when you have finished childbearing.
Do symptoms go away after menopause?
Symptoms most often go away after menopause. Surgery to remove the uterus often gets rid of symptoms completely.
Sources
- NCBI Bookshelf - Adenomyosis (StatPearls)
- MedlinePlus - Adenomyosis
- American College of Obstetricians and Gynecologists - Heavy Menstrual Bleeding
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
