Affecting 20-35% of women, pain and symptoms associated with adenomyosis can overlap with endometriosis and even co-exist with the condition, but adenomyosis is caused by invasive growth of endometrial-like tissue into the uterus.
Similar to endometriosis, adenomyosis uteri, or just adenomyosis, is the presence of ectopic endometrial tissue in the muscle layer of the uterus without a direct connection to the endometrium. It is, essentially, endometriosis of the uterus. Pain associated with adenomyosis can be debilitating and persistent, even after surgical removal of endometrial tissue.
While the severity of chronic pelvic pain symptoms range, symptoms are usually related to gynecologic, urologic, gastrointestinal, and musculoskeletal conditions and exhibit a wide range of symptoms in both women and men.
As the ectopic endometrial tissue proliferates, the uterus takes on an enlarged, globular shape, which can sometimes be appreciated on examination typically in conjunction with marked tenderness.
Prolonged menstrual cramps 
Spotting between periods 
Heavy menstrual bleeding 
Blood clots during menstrual bleeding
Pain during intercourse 
Tenderness in the centralized abdominopelvic area 
Because the causes of adenomyosis are not fully known, medical professionals are not exactly sure of the risk factors, but data shows us these risk factors may include:
Adenomyosis appears to be more common in women who have had children, then those who have not. This relationship may be biased, given that adenomyosis is typically diagnosed at the time of hysterectomy.
Prior uterine surgery, such as a cesarean section or fibroid removal.
There appears to be wide variations in the incidence of adenomyosis between racial and ethnic groups and different geographic regions. It is not clear whether this is due to patient factors or differences in diagnosis.
Symptomatic adenomyosis usually is manifested in women aged 35 to 50 years, although adenomyosis can be found in asymptomatic women.
Women may experience symptomatic adenomyosis because of family history and genes.
While diagnosing adenomyosis definitively requires a histological diagnosis, meaning that the uterus has to be sent for pathological evaluation after hysterectomy, our team can also use additional modes to provide a suspected diagnosis.
Here’s what you can expect when you are a patient at Pelvic Rehabilitation Medicine:
Step One – First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.
Step Two – Next, an external exam of your hips, abdomen, and posterior sacrum.
Step Three – Next, your pelvic nerves are evaluated externally with a soft cotton tip.
Step Four – Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.
Step Five – Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on exam.
Step Six – Oftentimes, treatment can be started the same day as there is no down time. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.
Adenomyosis isn’t necessarily harmful. However, the symptoms can negatively affect your quality of life. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities such as sexual intercourse. A surgical Hysterectomy is a definitive treatment for Adenomyosis. However, many patients do want a hysterectomy particularly if they want to have children in the future they are looking to preserve their Uterus. Therefore, at PRM we offer a proprietary office-based procedure to treat the symptoms of adenomyosis for those looking to avoid a hysterectomy. This treatment consists of a series of pelvic nerve and muscle treatments to directly target spastic pelvic floor muscles, inflammation in the pelvis, and nerve pain. Depending on the patient’s individual presentation, other modalities may be needed in addition to our treatment.
Similar to endometriosis, adenomyosis uteri, or just adenomyosis, is the presence of ectopic endometrial tissue in the muscle layer of the uterus without a direct connection to the endometrium. It is, essentially, endometriosis of the uterus. Pain associated with adenomyosis can be debilitating and persistent, even after surgical removal of endometrial tissue.
Because the causes of adenomyosis are not fully known, medical professionals are not exactly sure of the risk factors, but data shows us these risk factors may include:
Adenomyosis appears to be more common in women who have had children, then those who have not. This relationship may be biased, given that adenomyosis is typically diagnosed at the time of hysterectomy.
Prior uterine surgery, such as a cesarean section or fibroid removal.
There appears to be wide variations in the incidence of adenomyosis between racial and ethnic groups and different geographic regions. It is not clear whether this is due to patient factors or differences in diagnosis.
Symptomatic adenomyosis usually is manifested in women aged 35 to 50 years, although adenomyosis can be found in asymptomatic women.
Women may experience symptomatic adenomyosis because of family history and genes.
While diagnosing adenomyosis definitively requires a histological diagnosis, meaning that the uterus has to be sent for pathological evaluation after hysterectomy, our team can also use additional modes to provide a suspected diagnosis.
Here’s what you can expect when you are a patient at PRM:
Step One – First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.
Step Two – Next, an external exam of your hips, abdomen, and posterior sacrum.
Step Three – Next, your pelvic nerves are evaluated externally with a soft cotton tip.
Step Four – Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.
Step Five – Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on exam.
Step Six – Oftentimes, treatment can be started the same day as there is no down time. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.
Take the first step towards your healing journey by booking a free 15-minute consultation or new patient visit with a pelvic pain specialist today.
Dr. Allyson Shrikhande, PRM’s Co-Founder and Chief Medical Officer, served as medical reviewer and expert source…
Dr. Allyson Shrikhande had a blog published in Rosy discussing Chronic Pelvic Pain Syndrome (CPPS).
Dr. Allyson Shrikhande had a discussion with Dr. Melanie Carminati of Inspira Physical Therapy.
In this episode of the Period Party Podcast, Dr. Shrikhande and Nicole Jardim talk about the…
