Gineclinic
Gynecology clinic in Sarrià-Sant Gervasi
C/ Lázaro Cárdenas, 4 · 08017 Barcelona
Area of expertise
Adenomyosis
Endometrial tissue grows into the muscular wall of the uterus. It can cause very heavy and painful periods and, for years, it has been mistaken for fibroids or gone unnoticed.
Symptoms that raise suspicion
- Very heavy periods, with clots, that last longer than usual
- Severe, progressive period pain that gets worse over the years
- A feeling of constant heaviness or pressure in the pelvis
- An enlarged uterus that is tender on examination
- Bleeding between periods or prolonged spotting
- Pain during sex
- Iron-deficiency anemia caused by the bleeding
- Difficulty getting or staying pregnant
You don't need to have all the symptoms. If you have two or three that affect your life, it is worth looking into.
What is adenomyosis
In adenomyosis, endometrial tissue (glands and stroma) infiltrates the myometrium, the muscular layer of the uterine wall. This hormone-sensitive tissue becomes inflamed with each cycle, and the surrounding muscle reacts by thickening. The result is a larger, stiffer, more painful uterus, with abnormal contractions that contribute to heavy bleeding and pain.
It can be diffuse, when it extensively affects the uterine wall, or focal, when it forms a well-defined nodule (adenomyoma) that is easily mistaken for a fibroid on an ultrasound that is not targeted.
It coexists with endometriosis in a high proportion of patients, but it is not the same thing: endometriosis is outside the uterus, while adenomyosis is in its wall. And the treatment is not identical.
The usual confusion: adenomyosis, fibroids and endometriosis
| Feature | Adenomyosis | Fibroid | Endometriosis |
|---|---|---|---|
| Where it is | Inside the muscular wall of the uterus | A smooth-muscle nodule in the wall or cavity of the uterus | Outside the uterus (peritoneum, ovary, rectovaginal septum, bowel) |
| Main symptom | Heavy periods + severe pain | Heavy periods, sometimes without pain | Pelvic pain, pain during sex, dysmenorrhea |
| Ultrasound appearance | Asymmetrically thickened wall, small cysts in the muscle, fan-shaped shadowing and an irregular endometrial-myometrial junction | Well-defined nodule with a clear outline | Nodules outside the uterus, loss of mobility, endometriomas |
| Is it easy to see? | Only if specifically looked for | Yes | Deep endometriosis only with a targeted protocol |
How it is diagnosed
The diagnosis is based on symptoms and ultrasound. Neither surgery nor a biopsy is needed to establish it.
Targeted transvaginal ultrasound
The signs looked for are specific: asymmetric thickening of the myometrium, myometrial cysts, subendometrial lines and buds, heterogeneous echogenicity and an irregular or interrupted endometrial-myometrial junction. The standardized criteria of the international MUSA consensus are applied, not a general impression.
MRI
Useful when the ultrasound is inconclusive, when associated fibroids blur the picture, or to plan uterus-sparing surgery.
Treatment
The goal is twofold: to control the bleeding and to control the pain, preserving the uterus when pregnancy is desired or when the patient prefers it.
Medical treatment
- Levonorgestrel intrauterine system (LNG-IUS): often the most effective option for heavy bleeding, with good long-term tolerability.
- Progestogens or continuous combined hormonal contraception: they suppress the cycle and reduce the repeated hormonal stimulus.
- GnRH agonists or oral antagonists: in selected cases or before surgery, to reduce the size of the uterus and the bleeding.
- Tranexamic acid and anti-inflammatories: occasional support during your period.
- Correcting iron deficiency: many patients arrive with anemia that has gone untreated for years. Correcting it noticeably improves tiredness, usually within a few weeks.
Interventional and surgical options
When medical treatment does not work or is not tolerated: uterine artery embolization, resection of focal adenomyomas in selected cases and, as a last resort, hysterectomy, which is the only definitive treatment. The decision is made by considering your age, your wish to have children and the real impact on your life, never just the size of the lesion on the image.
Adenomyosis and pregnancy
Adenomyosis can reduce the chances of implantation and increase certain obstetric risks, but many women with adenomyosis have normal pregnancies. If pregnancy is desired, treatment should be planned with that goal from the start and, if necessary, coordinated with a fertility unit.
Frequently asked questions about adenomyosis
Is adenomyosis the same as endometriosis?
No. In endometriosis the tissue is outside the uterus; in adenomyosis it has infiltrated its muscular wall. They often coexist and both depend on hormones, but they are different conditions and the treatment is not identical.
Does the uterus need to be removed?
In most cases, no. Hysterectomy is the only definitive treatment, but it is the last step. Before that there are effective medical options that make it possible to keep the uterus and control bleeding and pain for years.
I was told I have fibroids, but the pain doesn't fit. Could it be adenomyosis?
It is a common confusion, especially with focal adenomyosis. If your main symptom is severe pain in addition to bleeding, and the image does not quite match a fibroid, it is worth repeating the ultrasound with a protocol targeted at adenomyosis.
Can it appear after 40?
Yes. It used to be diagnosed mainly between the ages of 35 and 50, but with today's ultrasound it is increasingly detected in young women, and symptoms usually start long before the diagnosis. Period pain that gets worse over the years is one of its most characteristic clues.
References
- Harmsen MJ, Van den Bosch T, de Leeuw RA, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118-31. doi:10.1002/uog.24786 · PubMed
- As-Sanie S, Mackenzie SC, Morrison L, et al. Endometriosis: a review. JAMA. 2025;334(1):64-78. doi:10.1001/jama.2025.2975 · PubMed
- Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. doi:10.1093/hropen/hoac009 · PubMed
Related areas
Where I practice
Private practice and public hospital practice
I have a private practice at two centers in Barcelona and continue my public hospital practice at Hospital Clínic. They are two different routes: for the private practice you can book an appointment directly; the public hospital is accessed by referral.
Private practice Book an appointment directly
Women's Clínica Ginecológica
Women's health specialty center
Vía Augusta, 257 · corner of Ronda General Mitre · 08017 Barcelona
Monday to Thursday, 8:30 a.m. to 8:30 p.m. · Friday, 8:30 a.m. to 3:00 p.m.
Public hospital practice Public health system
Hospital Clínic de Barcelona
Endometriosis Unit
Senior Consultant Gynecologist and Lead, Chronic Pelvic Pain Clinic · Institut Clínic de Ginecologia, Obstetrícia i Neonatologia
C/ Villarroel, 170 · 08036 Barcelona
My practice at Hospital Clínic de Barcelona is part of the public health system and does not accept direct appointment requests: patients are seen through the usual channels of the health system, by referral from your primary care physician or from another specialist.
This website does not handle emergencies
If you have sudden, severe pain, a fever, heavy bleeding, or you are pregnant and something is not right, do not wait for an appointment: go to an emergency room or call 112.