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Uterine Adenomyosis

By S. Gene McNeeley, MD, Clinical Professor; Chief of Gynecology, Center for Advanced Gynecology and Pelvic Health, Michigan State University, College of Osteopathic Medicine; Trinity Health

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Uterine adenomyosis is the presence of endometrial glands and stroma in the uterine musculature; it tends to cause a diffusely enlarged uterus.

In adenomyosis, the ectopic endometrial tissue tends to induce diffuse uterine enlargement (globular uterine enlargement). The uterus may double or triple in size but typically does not exceed the size of a uterus at 12 wk gestation.

True prevalence is unknown, partly because making the diagnosis is difficult. However, adenomyosis is most often detected incidentally in women who are being evaluated for endometriosis, fibroids, or pelvic pain. Higher parity increases risk.

Symptoms and Signs

Common symptoms of uterine adenomyosis are heavy menstrual bleeding, dysmenorrhea, and anemia. Chronic pelvic pain may also be present.

Symptoms may resolve after menopause.


  • Usually ultrasonography or MRI

Uterine adenomyosis is suggested by symptoms and diffuse uterine enlargement in patients without endometriosis or fibroids. Transvaginal ultrasonography and MRI are commonly used for diagnosis, although definitive diagnosis requires histology after hysterectomy.

Needle biopsy is done only occasionally (eg, when endometrial cancer needs to be excluded); its accuracy can be limited, primarily by sampling error.


  • Hysterectomy

The most effective treatment for uterine adenomyosis is hysterectomy.

Hormonal treatments similar to those used to treat endometriosis may be tried. Treatment with oral contraceptives can be tried but is usually unsuccessful. A levonorgestrel-releasing IUD may help control dysmenorrhea and bleeding.

Key Points

  • In uterine adenomyosis, the uterus may double or triple in size.

  • It commonly causes heavy menstrual bleeding, dysmenorrhea, and anemia and may cause chronic pelvic pain; symptoms may resolve after menopause.

  • Diagnose by transvaginal ultrasonography and/or MRI; however, definitive diagnosis requires histology after hysterectomy.

  • The most effective treatment is hysterectomy, but hormonal treatments (eg, oral contraceptives) can be tried.

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