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Adenomyosis vs. Endometriosis: What You Need To Know

Here are some key differences between adenomyosis and endometriosis

Source links contain gendered language; discussions of fertility and cannabis.

Disclaimer: This blog is meant as an educational resource and does not recommend or discourage the use of cannabis products. If you do decide to use cannabis, please use it responsibly.

April is Adenomyosis Awareness Month, and many patients and health-care practitioners who suspect endometriosis could benefit from understanding the nuances between the two illnesses. The Endometriosis Network Canada looks at the significant differences not only in symptoms, but in diagnosis and treatment as well. 

What is it?

While endometriosis (endo) is characterized by tissue similar to the endometrium that lines the uterus, adenomyosis occurs when endometrial tissue itself grows into the muscle wall of the uterus.

Many people have both conditions – one study found adenomyosis in one of every five people who received surgical diagnosis of endo – but they do exist independently.

Did you know: adenomyosis was once called endometriosis interna, until the two were discovered to be pathologically and clinically different.

For many years, the only definitive diagnosis of adenomyosis was found post-hysterectomy in perimenopausal cisgender women who experienced heavy bleeding. Because of this, the condition was closely associated with childbirth and those who had given birth more than once.

However, recent years are proving that, like endo, adenomyosis is present in folks much younger and independent of childbirth, and contributes to distressing symptoms like severe pain and very heavy bleeding.
 
Symptoms

Much like the one in every four or five people with endo who live mostly symptom-free, many people with adenomyosis do not experience symptoms, but the disease can cause:

  • Severe menstrual cramps often described as ‘knifelike’
  • Abdominal pressure and bloating
  • Heavy, prolonged bleeding – including large clots or flooding
  • People may also notice painful sex or issues with fertility, and these along with pain and bleeding are often the main reasons people seek medical attention.

Diagnosis

Fortunately, it is possible to diagnose adenomyosis without surgery. Research has found that imaging techniques like transvaginal ultrasound and MRI have been successful in diagnosing adenomyosis, combined with clinical symptoms and a pelvic exam.

Rarely, a doctor may take a sample of endometrial tissue to biopsy and rule out any other serious conditions. This can happen during a laparoscopy for endometriosis.

The cause of adenomyosis isn’t known, but there have been many theories from invasive tissue growth due to surgery, to developmental origins in the womb, to inflammation of the uterus after childbirth. So, like endo, it’s still unclear.

Disease management

First and foremost, it is important to work with your doctor to develop a treatment plan that is right for you and your life goals.

Disease management for adenomyosis can look similar to endometriosis, including anti-inflammatories to reduce blood flow and relieve pain. Hormonal medications are common as well, primarily progestin-only types like an IUD, or GnRH agonists, artificial hormones that prevent natural ovulation.

There are more studies coming out that suggest cannabis may alleviate some symptoms, especially when inserted vaginally or taken orally. One study suggests there are fewer active cannabinoid receptors in those with adenomyosis, and regular use of medicinal cannabis can activate those receptors, providing more opportunity for symptom relief.

Understanding the relationship between cannabis and endometriosis:

Many other protocols for endometriosis, such as eating anti-inflammatory foods, meditation, and gentle movement are suggested by healthcare providers to help manage adenomyosis symptoms as well.

How it’s different from endo

As it directly affects the uterus, adenomyosis can cause the extreme abnormal or heavy bleeding that is often incorrectly associated with endo. If this is one of your main symptoms, consider mentioning adenomyosis to your doctor or specialist as a potential diagnosis.

But here’s the best part (is there really a best part?): unlike endometriosis, adenomyosis can be cured.

How, you ask?

By performing a hysterectomy.

That’s right, removing the uterus (the ovaries can stay) will remove all adenomyosis from the body! Why? Because adenomyosis occurs within the muscle walls of the uterus.

The decision to have a hysterectomy should never be taken lightly, and should always be presented to patients alongside the treatment options mentioned above.

Unfortunately, a hysterectomy is often touted as a cure for endometriosis, which it is not, as endometriosis occurs outside of the uterus.
 
Why you should care

While there is some overlap in symptoms and disease management, there are certainly benefits to understanding the difference between the two. If you are still searching for answers, knowing the other possibilities out there helps narrow down your quest – and treatment – which may help you find some peace.

The content of this post does not provide or replace medical advice. It is important to follow up with your doctor with any healthcare concerns you may have and to work with medical professionals to develop treatment plans that are right for you.