Adenomyosis: The Heavy Flow and Period Pain Diagnosis That’s Often Missed

Spotting between periods, heavy flow, and period pain–a few gynaecologic conditions can cause these symptoms. In fact, some of these conditions come bundled like a package. In this solo episode of Phase to Phase: The Hormone Health Show, Dr. Anne Hussain covers one of these conditions: Adenomyosis. She breaks down what adenomyosis actually is (in plain language), why it's so often missed, what it means for you and your fertility, and risk factors worth paying attention to. She also tackles the fertility conversation that rarely gets enough airtime, the diagnostic delays that leave so many people missing out on life, and management options, from the hormonal IUD and surgical approaches to the integrative strategies and physical therapies like pelvic floor physio (often borrowed from endometriosis data as research has historically lumped these conditions together). She also covers the often-overlooked definition of heavy and abnormal bleeding, the costs associated with adenomyosis, and how to advocate for yourself so that you get the care you deserve.

Key Takeaways

• What is adenomyosis? Adenomyosis is a condition where tissue similar to the uterine lining grows into the muscular wall of the uterus, often causing heavy menstrual bleeding, painful periods, and sometimes a tender or enlarged “boggy” uterus. It affects an estimated 20–35% of premenopausal menstruators and frequently coexists with endometriosis, fibroids, and polyps.

• What are the symptoms of adenomyosis? The hallmark symptoms are heavy flow and painful periods (dysmenorrhea), but adenomyosis can also cause chronic pelvic pain, painful sex, bloating, and fatigue from iron deficiency. Around 30% of cases are asymptomatic.

• What counts as heavy bleeding or abnormal uterine bleeding? Heavy menstrual bleeding is clinically defined as losing more than 80mL per period, periods lasting longer than 7-9 days, clots bigger than an inch across, flooding, or needing to double up on period products. Significant changes from your own baseline also matter, even if your numbers technically still fall within "normal" range. The cost of heavy bleeding and period pain–money spent on period products, days of work and life that are missed, energy and time spent to find appropriate care–are under-supported aspects of menstrual health.
• How is adenomyosis diagnosed? Transvaginal ultrasound is now a highly accurate diagnostic tool for adenomyosis, with closer to 90% sensitivity and specificity, making it more accessible and affordable than MRI. Advocate for imaging if your symptoms fit, and/or ask for a referral to a gynaecologist.
• How does adenomyosis affect fertility and pregnancy? The numbers aren’t super clear because adenomyosis often occurs with other gynaecologic conditions. That said, adenomyosis is associated with higher rates of pregnancy loss, preeclampsia, preterm delivery, and complications in assisted reproductive technology (ART) settings. Early referral to a fertility clinic and understanding your individual health are important.
• What are the treatment options for adenomyosis? There’s no one-size-fits-all solution for adenomyosis. Options include painkillers like NSAIDs for period pain, combined oral contraceptives for pain and flow, the hormonal IUD (currently considered first-line), progestin-only therapies, conservative surgery, and hysterectomy. Integrative strategies are usually borrowed from endometriosis research (nutrition, exercise, pelvic physiotherapy, acupuncture, and supplements like ginger, omega-3s, addressing a vitamin D deficiency, ensuring iron adequacy, PEA) can support symptom management and long-term health alongside conventional care. This should be a shared decision made based on your goals, health status, values, and symptoms.

Chapters

00:00 Adenomyosis stats

01:30 What is adenomyosis?

5:58 Risk factors

6:53 Diagnotic imaging

7:42 Infertility and fertility considerations

8:53 Conventional treatment

10:59 Integrative treatment options

14:39 Self-advocacy and tips

Dr. Anne's links:

What is a Normal Period Podcast Episode phasetophase.ca annehussain.com

References PMID: 30969690, 37837497, 37809195, 39718325

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