Quick answer. Adenomyosis is a benign condition where endometrial tissue grows into the muscular wall of the uterus, causing heavy, painful periods and an enlarged, tender womb. It is not cancer, and a range of medical and surgical treatments can control the symptoms.
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Adenomyosis is a common but often under-recognised cause of heavy and painful periods in Singapore. It happens when the tissue that normally lines the womb (the endometrium) grows into the thick muscle wall of the uterus, making the womb enlarged, boggy and tender. Many women live with the symptoms for years before the condition is named, often assuming heavy bleeding and cramping are just “normal”.
It is most often diagnosed in women in their late 30s and 40s, particularly after childbirth, though it can occur earlier. Adenomyosis is benign and not the same as cancer. This guide explains how it differs from endometriosis and fibroids, how a gynaecologist diagnoses it, and the treatment options available, from medication to surgery.
At a glance
| Condition | Where the problem is | Typical features |
|---|---|---|
| Adenomyosis | Endometrial tissue inside the uterine muscle wall | Heavy, painful periods; diffusely enlarged, tender uterus |
| Endometriosis | Endometrial-like tissue outside the uterus (ovaries, pelvis) | Pelvic pain, painful sex, sometimes fertility issues |
| Fibroids | Benign muscle growths in or on the uterine wall | Often firm, discrete lumps; heavy bleeding, pressure symptoms |
| Can they coexist? | Yes – all three commonly occur together | A scan or MRI helps tell them apart |
| Cancer risk | All three are benign | Persistent abnormal bleeding still needs assessment |
What is adenomyosis?
Adenomyosis is a condition in which the glandular tissue that normally lines the cavity of the womb becomes embedded within the muscular wall of the uterus. With each menstrual cycle this trapped tissue responds to hormones, swelling and bleeding inside the muscle. Over time this makes the uterus enlarged, thickened and tender.
It is a benign (non-cancerous) condition. Adenomyosis tends to affect women who have had children and is most commonly recognised in the late 30s and 40s, although it can occur in younger women too. It is increasingly diagnosed in Singapore as imaging has improved. It often coexists with endometriosis or fibroids, which is one reason the symptoms can overlap and the diagnosis can be missed for years.
Symptoms & signs
Some women have few symptoms, while others find adenomyosis significantly affects daily life. Common features include:
- Heavy menstrual bleeding – prolonged or very heavy periods, sometimes with clots
- Painful periods (dysmenorrhoea) that may be severe and worsen over time
- A feeling of pelvic heaviness, pressure or bloating
- An enlarged, tender uterus that a doctor may feel on examination
- Pain during intercourse
- Tiredness or breathlessness if heavy bleeding leads to anaemia (low iron)
Symptoms often settle naturally after menopause, when hormone levels fall.
Causes & risk factors
The exact cause of adenomyosis is not fully understood. The leading theory is that the boundary between the womb lining and the muscle is disrupted, allowing endometrial tissue to grow inward. Several factors are linked with a higher chance of developing it:
- Previous childbirth, especially having had several pregnancies
- Prior uterine surgery, such as a caesarean section or removal of fibroids
- Being in the later reproductive years (late 30s to 40s)
- Higher lifetime exposure to oestrogen
Because adenomyosis is driven by hormones, it tends to improve once the ovaries stop producing oestrogen after menopause.
How adenomyosis is diagnosed
A gynaecologist will start with your menstrual history and a pelvic examination, which may reveal an enlarged, tender uterus. Because the symptoms overlap with fibroids and endometriosis, imaging is important to confirm the diagnosis:
- Pelvic ultrasound – often the first scan, frequently done transvaginally; it can show a thickened, irregular uterine muscle
- MRI of the pelvis – gives the clearest picture and is helpful when the diagnosis is uncertain or surgery is being planned
- Blood tests – to check for anaemia caused by heavy bleeding
A definitive diagnosis was traditionally only possible by examining the womb after a hysterectomy, but modern ultrasound and MRI now allow it to be diagnosed reliably without surgery.
Treatment options
Treatment depends on how troublesome your symptoms are, your age, and whether you wish to preserve fertility. Options range from medication to surgery:
- Pain relief – anti-inflammatory painkillers (such as NSAIDs) for period pain
- Hormonal treatments – the hormonal intrauterine system (a progestogen-releasing IUD), the combined or progestogen-only pill, to reduce bleeding and pain
- Tranexamic acid – a non-hormonal medicine taken during periods to reduce heavy bleeding
- Iron supplements – to treat anaemia from blood loss
- Uterine artery embolisation – a minimally invasive procedure to reduce blood supply to the affected area, in selected cases
- Hysterectomy – surgical removal of the uterus is the only definitive cure and may be considered for severe symptoms once a woman has completed her family
Your gynaecologist will help you weigh these options against your symptoms and future plans.
When to see a doctor & which specialist
See a doctor if you have persistently heavy or painful periods, periods that are getting worse, or symptoms of anaemia such as tiredness and breathlessness. While adenomyosis itself is benign, abnormal bleeding should always be assessed to rule out other causes.
Seek urgent care, or go to A&E, if you have very heavy bleeding soaking through pads every hour, severe sudden pelvic pain, fainting, or signs of significant blood loss. In an emergency, call 995.
A gynaecologist is the right specialist to diagnose and manage adenomyosis. You can find one through our directory of the best gynaecologists in Singapore.
Managing symptoms day to day
While medical treatment controls adenomyosis, some everyday measures can ease symptoms and protect your health. If periods are heavy, ask your doctor to check your iron levels, as anaemia is common and treatable; iron-rich foods and supplements can help. A heat pack, gentle activity and anti-inflammatory painkillers taken early in a period may ease cramps. Tracking your cycle, bleeding and pain in a diary or app gives your gynaecologist useful information and helps measure whether treatment is working.
Special situations
If you are planning a pregnancy, tell your gynaecologist, as this influences which treatments are suitable; some options, such as the hormonal coil or surgery, are not compatible with trying to conceive. Adenomyosis symptoms usually ease after menopause, when oestrogen levels fall.
Questions to ask your doctor
- Could I also have fibroids or endometriosis?
- Which treatment best fits my symptoms and family plans?
- Should my iron levels be checked?
Common questions
Is adenomyosis cancer?
No. Adenomyosis is benign. However, any abnormal or unusually heavy bleeding should still be assessed to exclude other causes.
Will I need a hysterectomy?
Not necessarily. Many women manage well with hormonal treatments or other measures; hysterectomy is the only definitive cure and is usually considered only for severe symptoms once a family is complete.
Related guides
- Best Gynaecology Clinics in Singapore — our editorial shortlist
- gynaecology clinics directory
- Bronchoscopy
- Pleurisy
- Laminectomy
- De Quervain's
- Dupuytren's
Sources
- Mayo Clinic – Adenomyosis
- NHS – Heavy periods
- HealthHub Singapore – Women's Health
- SingHealth – Menstrual Disorders
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