Adenomyosis and Infertility


The uterus wall consists of 3 layers; the inner layer is endometrium. Endometrium gets ready for pregnancy each month. If pregnancy does not occur, then the endometrium is shed during the menstrual cycle. The middle layer is myometrium composed of muscle cells. The outer layer is perimetrium.

Adenomyosis is a benign (non – cancerous) condition which occurs in the uterine layers. In this condition, endometrial cells of endometrium penetrate into the muscle of uterus (myometrium layer). This condition is also called “Endometriosis of uterus”. Due to this condition, the uterine wall becomes thick.  


Some women may be completely asymptomatic with adenomyosis being diagnosed first time on an ultrasound. Most common sign and symptoms of adenomyosis are

  • Heavy, painful, and prolonged menstrual bleeding
  • Blood clots during menstrual bleeding
  • Pain during intercourse
  • Pre-menstrual pelvic pain and discomfort

The causes of adenomyosis are unknown. But there are numerous studies which explain the causes of this condition. According to few studies, various hormones including estrogen, progesterone, prolactin, and follicle stimulating hormone (FSH) may cause adenomyosis. It is diagnosed in middle age women (late 30s and 40s). Commonly, women with adenomyosis may also have or developed endometriosis. Endometriosis is leading cause of infertility in women. The relationship between adenomyosis and infertility is still controversial. It is difficult to conclude that adenomyosis may cause infertility in later reproductive age. But according to various clinical studies, adenomyosis is associated with infertility by

  • Disrupting the sperm movement in the woman’s genital track by uterine contractions
  • Altering endometrial functions
  • Increase the chances of miscarriage in pregnant woman

Adenomyosis is a treatable condition. Treatment of adenomyosis depends on symptoms and severity of the condition. If the primary symptoms are those of pain and not fertility, adenomyosis treatment includes

  • Anti – inflammatory medications (if symptoms are mild to moderate)
  • Hormonal therapy (in case of heavy bleeding during menstrual cycle)
  • Uterine artery embolization (minimally invasive treatment for noncancerous growths in the uterus) Endometrial ablation (surgically destroys the lining of uterus –endometrium to reduce menstrual flow)

If a woman is diagnosed with adenomyosis and she is planning to conceive, she should immediately consult with infertility specialist and start treatment. Because in some cases, adenomyosis may damage uterus wall and interrupt the fetal implantation in the uterus. In severe cases, adenomyomectomy may be required in expert hands to restore normal uterine size and volume.

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