Endometriosis Vs. Adenomyosis: How to Tell the Difference

The Difference Between Two Common Gynecological Diseases

“That time of the month” is always at least a little bit uncomfortable for women, but for some, painful periods can leave them totally out of commission both before and during their periods. For these painful menstruation sufferers, the possibility their symptoms may come from endometriosis, one of the most common gynecological diseases, has probably crossed their mind, if not their Google search results. The disease has gained increased visibility as celebrities like Whoopi Goldberg, Susan Sarandon, Dolly Parton, and Padma Lakshmi all have come out publicly as endometriosis sufferers. In a Twitter post, the singer Halsey reached out to others diagnosed with the disease, saying, “I know how excruciatingly painful it can be and how discouraging the disease can be,” and described her diagnosis as “the most bittersweet moment because it meant [she] wasn’t crazy!”


Endometriosis affects over 5.5 million women in North America alone, and can lead to painful periods and intercourse, fatigue, diarrhea, and 40% of cases experience some form of infertility. Obviously, this is extremely concerning for any woman whose symptoms lineup with those of endometriosis, but what about those whose symptoms don’t exactly line up? For them, there’s actually another disease that could be the root of their pain and distress. It’s called adenomyosis, and although it is similar to endometriosis, it requires its own line of treatment.


So What’s the Difference?


Although adenomyosis and endometriosis can occur together, they are not the same condition, and it is important to know the differences. Endometriosis is caused when the cells lining the uterus (endometrial cells) grow outside the uterus. During your period, the endometrial tissue thickens and breaks down, causing bleeding. In patients with endometriosis, the broken down tissue has nowhere to go, causing severe pain during your menstrual cycle. In some cases, cysts called endometriomas form, irritating the surrounding tissue and causing scarring.


While adenomyosis also involves endometrial tissue, it is its own distinct problem, with its own distinct set of symptoms. With adenomyosis, the endometrial cells grow into the muscular walls of the uterus, rather than the uterine lining. Like endometriosis, these cells behave as they normally would during the menstrual cycle, thickening and breaking down. Unlike endometriosis, this causes the uterus to enlarge, and leads to heavy bleeding. Heavy bleeding is one of the main symptoms of adenomyosis, which can help patients identify it.

While endometriosis is typically found in women ages 25 to 35, adenomyosis skews a little bit older, more often affecting women within the 35- to 50-year-old range. In general, both diseases affect women in their reproductive years. The two are so similar that adenomyosis used to be called endometriosis interna, before being reclassified as its own, separate disease. For endometriosis, one of the biggest symptoms is chronic pelvic pain, whereas the telltale sign for adenomyosis is heavy menstrual bleeding, which occurs in 40-60% of adenomyosis patients. Since both diseases have such overlapping symptoms and demographics, figuring out which is the root of a patient’s symptoms requires help from a doctor.


How Do I Get Diagnosed?


If you believe you have endometriosis, the first step is getting a pelvic exam. Your doctor will manually feel for abnormalities in your uterus, such as cysts or scars. Just because your doctor doesn’t manually feel these abnormalities doesn’t mean they’re not there. The only surefire way to diagnose endometriosis is via a laparoscopy, in which a doctor makes a tiny incision underneath your navel to look for endometrial tissue outside the uterus. They may also take tissue samples for a biopsy.


Unfortunately, adenomyosis can be much trickier to diagnose. Until recently, the only way to diagnose adenomyosis was a hysterectomy, but now with advanced imaging technology there are more options. First, like with endometriosis, you’ll get a pelvic exam in which your doctor might identify an enlarged or tender uterus. Then, using an MRI or transvaginal ultrasound, your doctor can take a look at your uterus and its lining to identify if your uterus has been enlarged.

How Can I Get Treatment?

One you’ve been properly diagnosed, treatment can depend on what stage of life you’re in. With adenomyosis, symptoms typically go away after menopause, so if you’re in that phase of your life, the best treatment might just be to wait. If you’re nowhere near menopause, anti-inflammatory drugs and hormone treatments can help to manage symptoms. In severe cases, a hysterectomy may be recommended to stop painful symptoms.


For endometriosis sufferers, early diagnosis and treatment is key to managing possible fertility issues. Endometriosis patients may want to seek out a fertility specialist who can help assess their situation. Additionally, patients with severe symptoms may find surgical options are their best bet for alleviating pain, protecting fertility, and restoring their reproductive anatomy. While medical therapies like hormonal birth control or GnRH treatments might help to relieve symptoms like painful menstruation, they don’t address the underlying cause of the discomfort, or help with fertility.


As with all gynecological issues, both endometriosis and adenomyosis are deeply personal and individual diseases with symptoms ranging from mild to severe. If you fear you’re suffering from one, or both, of these diseases, the best way to get the care you need is to make an appointment for a pelvic exam with a doctor you trust. Your journey to treatment begins in the exam room.