Adenomyosis and endometriosis are two gynecological conditions that, although they share pelvic pain and may affect fertility, have different origins and treatments. Here you will find clear answers to understand each one, how they can influence your reproductive health, and when it’s time to seek medical support. What is adenomyosis and what causes it? Adenomyosis occurs when the tissue that lines the uterus (endometrium) grows into its muscular wall (myometrium). Each menstrual cycle, that internal tissue bleeds and thickens the uterus, causing very heavy periods, intense pain, and sometimes a feeling of pressure. Although the exact cause is not always known, it is associated with hormonal imbalances, previous surgeries, or uterine trauma. How does endometriosis differ? Endometriosis is the presence of tissue similar to the endometrium outside the uterus: ovaries, fallopian tubes, peritoneum, and other pelvic areas. That tissue responds to the menstrual cycle, causing inflammation, cysts (endometriomas), and adhesions, and often leads to chronic pain and fertility issues different from those of adenomyosis. Key symptoms Adenomyosis: – Very heavy and prolonged menstrual bleeding – Intense cramps – Feeling of uterine enlargement Endometriosis: – Chronic pelvic pain, especially before and during the period – Pain during intercourse (dyspareunia) – Digestive or urinary discomfort if lesions affect nearby organs Diagnosis Adenomyosis: pelvic ultrasound or magnetic resonance imaging showing a thickened uterine wall (>12 mm) and heterogeneous texture. Endometriosis: laparoscopy (minimally invasive surgery) to view and sample lesions. Ultrasound or MRI can detect endometriomas, but not superficial implants. Treatments to protect your fertility NSAIDs and pain relievers (always under medical supervision). Hormonal therapies: combined contraceptives, progestogens, GnRH agonists. Surgery: resection of adenomyotic tissue or ablation/excision of endometriotic implants. Assisted reproduction (IVF, ICSI) if you want to increase your chances of pregnancy. Talk to a fertility specialist before deciding. For more details on managing endometriosis, visit Endometriosis: A Complete Journey and Endometriosis and Fertility: A Simple Guide. Frequently Asked Questions 1. Can adenomyosis affect my chances of getting pregnant? Yes. As it grows within the myometrium, it can hinder implantation and alter uterine contractions, increasing the risk of miscarriage or preterm birth. However, with mild adenomyosis many women conceive naturally or with the help of assisted reproductive techniques. Proper diagnosis and treatment make a difference. 2. Does endometriosis always cause infertility? No, but more than 30% of infertile women have it. Adhesions and cysts can block the fallopian tubes and affect ovarian function. Fertility options like ovulation induction, IUI, or IVF have good outcomes if you follow a plan tailored to your case. 3. How can I relieve symptoms with lifestyle changes? An anti-inflammatory diet (rich in omega-3, low in ultra-processed foods), moderate exercise, stress management, and therapies like acupuncture can help. Support groups and psychotherapy also improve emotional well-being. 4. When should I consider surgery? If the pain is very intense, medications don’t work, or fertility is at risk. For adenomyosis, focal adenomyomectomy is performed; hysterectomy is reserved if you no longer wish to have children. In endometriosis, laparoscopy to remove lesions and adhesions can relieve pain and improve fertility. Sources American College of Obstetricians and Gynecologists. Obstetrics & Gynecology, 138(3), e1–e15 (2021). MedlinePlus. Adenomyosis. https://medlineplus.gov/ency/article/001513.htm World Health Organization. Endometriosis fact sheet. https://www.who.int/news-room/fact-sheets/detail/endometriosis Serralheiro et al. Pathophysiology of adenomyosis and endometriosis. Fertility and Sterility, 118(5), 925–934 (2022). Remember: every body is unique. If you suspect adenomyosis or endometriosis and want to preserve your fertility, consult a reproductive specialist. We are with you on this journey.