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Your period is at it again. Debilitating cramps, heavy bleeding, complete exhaustion, and nothing seems to help. If you’re starting to wonder if something more than a “bad period” could be to blame, these are just some of the common — and super frustrating — symptoms of endometriosis and adenomyosis. These two misunderstood (and often misdiagnosed) conditions can wreak havoc on your cycle, fertility, and overall well-being.
“Both endometriosis and adenomyosis can be difficult to diagnose, and for many women, the diagnosis is never made,” says Bruce Lessey, MD, PhD, a reproductive endocrinologist & infertility specialist and the scientific advisor at Cicero Diagnostics.
We’re here to help you understand the difference between these conditions and what symptoms to look out for so you can advocate for the care you deserve.
Is it adenomyosis or endometriosis?
The main difference between adenomyosis and endometriosis is in what tissue is responsible and where that tissue grows.
Dr. Lessey explains that when adenomyosis occurs, “endometrial-like tissue grows into the muscle wall of the uterus, thickening it and causing significant inflammation.” Because the tissue grows inside the uterine wall, the condition is sometimes called “internal endometriosis.”
Adenomyosis can cause heavy, painful, or prolonged periods, leg pain, and infertility, among other symptoms.
Endometriosis, on the other hand, is when tissue similar (but not identical) to the lining of the uterus grows outside the uterus in places it shouldn’t — like your fallopian tubes, ovaries, or internal abdomen lining. “This growth can make it difficult to get pregnant for a variety of reasons,” says Lessey. Women with unexplained infertility are especially likely to have endometriosis as an underlying cause of infertility.
Additional symptoms of endometriosis may include pain before, between, and during periods, gastrointestinal symptoms, and pain with sex, to name a few.
Because adenomyosis and endometriosis can cause similar symptoms, they often get misdiagnosed as dysmenorrhea (painful periods). For some women with endometriosis, infertility is their only symptom, and others have no symptoms at all, also known as silent endometriosis.
Uterine fibroids are another condition with symptoms similar to those of adenomyosis and endometriosis. “Fibroids are myometrial muscle cells that mutate and begin to grow, forming tumors inside or on the uterus,” adds Lessey. Some fibroids don't cause any symptoms, but others can cause severe menstrual cramps, heavy periods, and pain during sex.
How are adenomyosis and endometriosis diagnosed?
Thanks to recent technological advances, diagnosing adenomyosis and endometriosis is typically noninvasive. Most providers start with a physical exam to assess if your uterus is enlarged.
A transvaginal ultrasound often follows. Still, the accuracy can vary, and endometriosis might not show up. On average, it can take 7 to 9 years for women to get the correct diagnosis of endometriosis, as ultrasounds and MRIs may miss smaller patches of uterine tissue.
The only sure way to diagnose the condition is through laparoscopy, a minimally invasive surgery that can diagnose and remove endometriosis. For adenomyosis, magnetic resonance imaging (MRI) is the most reliable diagnosis method.
“Besides imaging or surgery, an endometrial biopsy using the ReceptivaDx test can help identify inflammation on the uterine lining most often associated with endometriosis or adenomyosis,” says Lessey. In fact, it's the only test that can identify leading causes of unexplained infertility in a single sample.
When to see a healthcare provider
While some discomfort during your period is normal, it’s important to trust your instincts and recognize when your symptoms may be signaling something more serious. You know your body best, and chalking things up to "just a heavy, painful period" could lead to potential complications down the road.
Also, although endometriosis is more common, it can often look a lot like adenomyosis, so talking to your provider and getting an ultrasound and an MRI to diagnose and rule out other conditions accurately is vital.
Adenomyosis, endometriosis, and fertility
When it comes to fertility, Lessey adds: “One of the biggest misconceptions is that of physicians who don’t think endometriosis or adenomyosis causes infertility or IVF failure. Whether a patient goes through her obstetrician or is already being seen in an IVF center, the likelihood of infertility caused by these conditions increases with the increasing number of failures, regardless of overt symptoms."
Remember, you are your own best advocate. If you are experiencing any concerning symptoms, or even if you’re unsure, contact your healthcare provider — and mention the ReceptivaDx test while you’re at it.
Early diagnosis and intervention can make a big difference in managing these conditions, improving your chances of conception, and minimizing their impact on your overall well-being.
Dealing with adenomyosis and endometriosis can be challenging, but you're not alone. There's support available, and you can find ways to manage your symptoms and live a fulfilling life.
Blair Sharp is a freelance writer who lives in Minnesota with her husband and son. Her words have been published in various publications, including Parents, SheKnows, The Bump, and Insider. Find her writing daily on LinkedIn and check out her weekly newsletter, Hey Freelancer! Head to her website www.blairsharp.com for more.
