Endometriosis or adenomyosis — what’s the difference?

It’s possible to have both conditions at the same time.

They are not always well understood or easy for doctors to recognise and diagnose, but specialist support is available.

In this article, King Edward VII’s Hospital consultant gynaecologist, Mr Arvind Vashisht, explains the difference between endometriosis and adenomyosis and how you can get a diagnosis and treatment.

What is endometriosis?

The cells that form the lining of the womb are called the endometrium. Endometriosis is the presence of endometrial tissue on other organs, usually within the pelvic cavity.

Endometrial tissue outside of the womb behaves in much the same way as it does inside the womb. It builds up, and then begins to bleed away. Normal endometrial tissue inside the womb leaves the body in the form of a period. Unfortunately, when it bleeds outside of the womb, it cannot leave the body and therefore builds up causing pain and discomfort.

The ovaries are most commonly affected by endometriosis. Other structures such as those supporting the womb (“uterosacral ligaments”) may be involved. Organs such as the fallopian tubes, bladder and the bowel can also be affected, which may interfere with bowel, bladder and sexual function. Occasionally, other affected areas may involve the belly button and scar tissue left behind from previous operations to the abdomen.

In severe cases, endometrial tissue can build up so much that it fuses pelvic organs such as the bowel and the womb together.

What are the symptoms of endometriosis?

Some women experience no endometriosis symptoms, but others can experience mild, moderate or severe symptoms.

The symptoms of endometriosis include:

• Pain in your lower abdomen and pelvis
• Pain during sex
• Pain when opening your bowels
• Pain on passing urine

These problems are particularly pronounced during your period. Living with the chronic symptoms of endometriosis can also cause you to feel tired or exhausted and can lead to feelings of depression.

Endometriosis also causes some women to experience fertility problems, but this is individual to each woman, and treatments are available.

How common is endometriosis and who does it affect?

Endometriosis is a very common condition, affecting around 1 in 10 women in the UK. It affects women who have reproductive potential — women having periods.

What causes endometriosis?

There are many different theories as to what causes endometriosis, including possible problems with the immune system, abnormal cell transport and retrograde menstruation. Retrograde menstruation means that some of the womb lining escapes backwards up the fallopian tubes, rather than out through the vagina during a period.

The theory is that womb lining cells move out of the fallopian tubes and settle onto the organs of the pelvis which develop as endometrial tissue. Many women experience retrograde menstruation, but some are naturally able to clear this tissue from their body.

Sometimes, having a family history of endometriosis can mean that you’re more likely to develop it yourself.

Diagnosing and treating endometriosis

It can be difficult to get a diagnosis of endometriosis. But if you think you have the condition and it’s affecting the quality of your life, it’s important to find a doctor who understands your condition. A specialised centre like the KEVII Endometriosis Centre can help.

Initially, your GP or specialist will examine your abdomen and vagina and ask some questions about your symptoms and your periods. You may also be offered an ultrasound scan of your abdomen and pelvis, or an MRI.

The most conclusive way of diagnosing endometriosis is by undergoing a laparoscopic surgical procedure. You’ll be asleep during this procedure, and your surgeon will pass thin surgical instruments through small cuts in your abdomen.

One of these instruments is a tube used to inflate your abdomen so that your surgeon can get a better look at the inside of your pelvic cavity. Another will be a camera to allow them to see conclusively if you have endometriosis.

If there is endometriosis present, your surgeon may use a laser tool to remove the patches of endometrial tissue that have formed. This will depend on your symptoms, the locations, and the severity of disease.

Other treatments for endometriosis include painkillers such as paracetamol or ibuprofen, or hormonal medications such as the contraceptive pill. Your GP or consultant will advise which medications could be best for you.

What is adenomyosis?

Endometriosis causes endometrial cells that form the lining of the womb to migrate outside of the womb. Conversely, adenomyosis causes these cells to move to the deeper layers of the wall of the womb, in the muscular layer called the myometrium.

These cells behave in the same way as the cells in the lining of the womb, thickening and bleeding with each menstrual cycle. Adenomyosis causes the walls of the womb to permanently thicken, leading to pain and heavier periods.

What are the symptoms of adenomyosis?

Some women experience no symptoms of adenomyosis, but others can experience the following:

• Painful and extremely heavy periods that may last longer than normal
• Passing large blood clots during menstruation
• Discomfort in the lower abdomen before their period starts

Some women may also experience pain during sex and when opening their bowels.

It is thought that, depending on the extent and distribution of disease, adenomyosis may be linked to difficulties falling pregnant. This is something that healthcare professionals may take into consideration if fertility is a concern. It is important to remember, however, that fertility is complex and multi-factorial, and that many women may have an incidental finding of adenomyosis and have no problems falling pregnant.

Having adenomyosis can put a strain on everyday life and lead some women to also experience fatigue and feelings of depression.

How common is adenomyosis and who does it affect?

Adenomyosis is a common condition, affecting the same number of women in the UK as endometriosis, around 1 in 10.

It’s most common in women in their 40s and 50s. It only affects women who haven’t been through the menopause and are still having their periods.

What causes adenomyosis?

The cause of adenomyosis is unknown.

As with endometriosis, genetics can play a part, meaning that if you have a family history of adenomyosis, you’re more likely to develop it.

There is no clear way to prevent adenomyosis from developing.

Diagnosing and treating adenomyosis

Adenomyosis can be even more difficult to diagnose than endometriosis. If you think you have the condition, it’s important to find a specialist doctor who can diagnose you.

The KEVII Endometriosis Centre can also help with diagnosing and treating adenomyosis, and our gynaecology department is staffed by experts who can advise on your best course of action.

Diagnosing adenomyosis usually involves your doctor examining your pelvic area from the outside and asking some medical questions relating to your symptoms and your periods.

You will usually have an MRI or internal transvaginal ultrasound scan. This involves your doctor placing a narrow probe into your vagina and viewing ultrasound images on a nearby screen to check the thickness of the walls of your womb. Adenomyosis causes the walls of the womb to thicken.

How adenomyosis is treated will depend on your circumstances and your age. Your consultant will discuss different treatment options with you if you’re planning to have children, or if you’re older and closer to your menopause.

Pain relief medications such as ibuprofen can help you manage your symptoms.

You may be prescribed drugs to help reduce the flow of your period, or hormonal medications such as the contraceptive pill or a special hormone releasing coil.

There are also surgical options available, that your specialist can talk you through.

More information

• To get a diagnosis of either endometriosis or adenomyosis, your GP is a good place to start. (Don’t have a GP?)
• If you’re struggling to get a diagnosis, or you’d like to explore your treatment options further, our specialist Endometriosis Centre will be able to help you.
• If you’re concerned that having endometriosis or adenomyosis is affecting your fertility, or may do in the future, you can discuss your options with our expert gynaecologists