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Adenomyosis
If your periods soak a pad in an hour or write off a week of work each month, the usual verdict is "you're just bad at periods." Often it's wrong. About one in five women in a gynaecology clinic have adenomyosis Naftalin et al. 2012: the uterine lining grows down into the muscle wall, so the organ bleeds harder and hurts more. The average woman waits years for the name. It matters because the treatments work, and the tax of "period week" can drop within a few months.
Condition Evidence Moderate Chapter Healthcare

It is common and badly missed. For decades it was found only in uteruses removed for other reasons, so it looked like a rare condition of older women. Better ultrasound changed that: scanning unselected clinic patients turns it up in about one in five 1. Roughly a third have no symptoms; the rest range from heavier periods to barely functional one week a month 2.

The bleeding drains you slowly. Cycle after cycle of heavy loss strips iron faster than food replaces it, and iron-deficiency anaemia is markedly more common here than in matched controls β€” it pulls down energy and exercise tolerance with it 2.

A scan is the way in. A transvaginal ultrasound from someone who knows the features catches about three in four cases, with few false alarms 3. A generic pelvic scan hunting for fibroids often misses it.

The move is to get it named, then treated β€” not to endure it. Most clinicians won't look unless you make them, so walk in with the ask ready.

What treatment buys back. A levonorgestrel IUD cuts menstrual bleeding by 70 to 90 percent and eases cramping within a few cycles 42; if it doesn't suit, daily dienogest brings pain scores down about six points on a ten-point scale 5.

  • First month: the overnight-pad drawer stops being daily-use, and the painkiller bottle stays on the shelf.
  • Months three to six: iron recovers, the 3 pm crash fades, and you get through a workday in the heavy week.
  • Year one: you stop scheduling your life around your period, because you no longer need to.
The fine print β€” when to skip it, and what people get wrong

It only hits women in their forties who've had kids. Older data said so because they only examined removed uteruses; ultrasound finds it in nulliparous women in their twenties 6. Hysterectomy is the only real fix is also false β€” the IUD and dienogest handle most cases without removing anything 4. It is the same as endometriosis: related and often coexisting, but a different disease inside the muscle rather than outside the uterus.

Quitting the IUD too early is the common one: irregular spotting is the rule for the first 8 to 12 weeks, then it settles into much lighter periods or none. Skipping the iron workup is another: ferritin drops long before haemoglobin does, so a normal haemoglobin without ferritin checked is incomplete.

References
  1. 1Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D (2012). How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Human Reproduction. link
  2. 2Loring M, Chen TY, Isaacson KB (2022). Adenomyosis: Diagnosis and Management. American Family Physician. link
  3. 3Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstetricia et Gynecologica Scandinavica. link
  4. 4Singh SS, Belland L, Leyland N, Murji A, Bougie O (2023). Guideline No. 437: Diagnosis and Management of Adenomyosis. Journal of Obstetrics and Gynaecology Canada. link
  5. 5Etrusco A, LaganΓ  AS, Chiantera V, Buzzaccarini G, Unfer V (2024). Dienogest treatment of symptomatic adenomyosis: An in-depth meta-analysis. European Journal of Obstetrics and Gynecology and Reproductive Biology. link
  6. 6Bourdon M, Santulli P, Marcellin L, Maignien C, Maitrot-Mantelet L, Bordonne C, Millischer AE, Plu Bureau G, Chapron C (2021). Adenomyosis: An update regarding its diagnosis and clinical features. Journal of Gynecology Obstetrics and Human Reproduction. link
Related in the handbook (5)
Helped by
  • β€” A hormonal IUD cuts the bleeding 70-90% and dulls the pain β€” usually the first thing to try.
  • β€” Logging how heavy and how painful your periods really are gives the gynaecologist the pattern that points at adenomyosis.
Related
  • β€” Adenomyosis is the close cousin β€” same painful, heavy periods, often coexisting; an ultrasound starts telling them apart.
  • β€” Adenomyosis is a frequent, under-diagnosed cause of heavy, painful periods β€” ask for the ultrasound.
  • β€” Adenomyosis causes the same heavy painful periods and often coexists; the ultrasound distinguishes them.
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