What Are the Non-Surgical Treatments for Adenomyosis?

The good news is that many women get good relief without surgery. This article explains how adenomyosis is recognized and the non-surgical options for treating it.

How do you know if you have adenomyosis?

Common symptoms include:

• Heavy or prolonged menstrual bleeding
• Severe menstrual cramps that may worsen over time
• Chronic pelvic pain, or a feeling of pelvic heaviness or bloating
• Pain during sex
• An enlarged, tender uterus found on exam

Adenomyosis is most often diagnosed in women in their 40s, but it is increasingly recognized in younger women. Some women have no symptoms. Because it depends on estrogen, adenomyosis usually quiets down after menopause.

How is it diagnosed?

Several uterine conditions cause similar symptoms, and adenomyosis often occurs alongside fibroids or endometriosis. Your clinician will take a history and may do a pelvic exam. A transvaginal ultrasound by an experienced sonographer can show the characteristic changes in the uterine wall, and MRI gives a more detailed picture when needed. Other causes of abnormal bleeding may also need to be ruled out.

What non-surgical treatments are available?

Anti-inflammatory pain relievers

NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve) reduce cramping and pelvic pain and can also lighten bleeding. They work best started at the first sign of your period and taken regularly for the first few days.

Hormonal treatments

Hormonal treatment is the main first-line therapy for adenomyosis. It reduces both bleeding and pain by thinning or quieting the tissue:

• The levonorgestrel IUD, which releases a progestin directly into the uterus and is one of the most effective options for heavy bleeding and pain
• Combined hormonal birth control (pill, patch, or ring), often taken continuously to skip periods
• Progestin-only options, such as norethindrone acetate pills, the injection, or the implant
• Medicines that lower estrogen, such as GnRH-based therapies, usually for a limited time because of side effects such as bone loss

Non-hormonal treatment

Tranexamic acid is a non-hormonal pill taken only during your period to reduce heavy bleeding. It is a good option for women who prefer to avoid hormones or who are trying to become pregnant. It does not treat pain, so it is often combined with an NSAID.

Procedures without surgery

For some women, uterine artery embolization, performed by an interventional radiologist, can reduce symptoms. Other options, such as focused ultrasound, are available at some centers.

Self-care

A heating pad or warm bath can ease cramps and pelvic pain. Regular exercise and good sleep may also help with chronic pain.

What if adenomyosis is not treated?

Adenomyosis does not turn into cancer. Without treatment, however, heavy bleeding can lead to iron deficiency anemia, and pain can worsen and interfere with work and daily life. Adenomyosis has also been linked to difficulty becoming pregnant and a higher risk of miscarriage. Symptoms usually improve after menopause.

When should you see a gynecologist?

See a clinician if you have heavy periods, severe cramps, pain during sex, pelvic heaviness, or ongoing pelvic pain. Seek care promptly if you feel dizzy, tired, or short of breath, which may be signs of anemia.

The bottom line

Adenomyosis is not cancerous, but its symptoms can disrupt your life, and it may affect fertility. Most women find relief with medication, especially the levonorgestrel IUD and other hormonal options. Hysterectomy is the only permanent cure, and it is reserved for women who have finished having children and have not gotten enough relief from other treatments.