How Is Adenomyosis Treated? Treatment Options Explained

Medical Writer: Janefrances Ugochi Ozoilo, MBBS, FMCPH, MSc (PH), PMP

Medical Reviewer:  Nnenna Chiloli, MBBS, MPH

Highlights

• Adenomyosis is a non-cancerous condition of the uterus that causes heavy bleeding, painful periods, and pelvic pain.
• Improved imaging now finds it in 20–35% of women under 40, and it affects about one-third of women evaluated for infertility.
• Women without troubling symptoms can monitor their condition and then seek treatment if necessary.
• Options range from mild to strong: NSAIDs and tranexamic acid for symptoms, hormonal treatments, and surgery.
• Hysterectomy is the only definitive cure, but uterus-preserving options can preserve fertility or avoid major surgery.
• The right treatment is determined by the  main symptom, pregnancy plans, age, disease severity, and personal preferences.

Introduction: What Is Adenomyosis?

Imagine dealing with your period every month, not just as a small inconvenience but as a major disturbance in your life. The cramps are so severe that you cannot go to work, and the bleeding is so heavy that you have to schedule your day around bathroom visits. 

For many women, this is not just an occasional bad month; it is a constant challenge. This is life with adenomyosis, a condition that often goes unnoticed for years.

Adenomyosis occurs when the lining of the uterus, called the endometrium, begins to grow into the muscular wall of the uterus, known as the myometrium. Even though it is in the wrong place, this lining still responds to monthly hormonal changes, so it bleeds and swells with each cycle. This can make the uterine wall thicker, painful, and often larger than normal. The main symptoms that you may notice are heavy menstrual bleeding, painful periods, and constant pelvic pain [1,2].

Adenomyosis, once thought to affect only women in their forties, is now more often identified in younger women due to improved ultrasound and Magnetic Resonance Imaging techniques. Studies using imaging, rather than surgery, have found adenomyosis in approximately 20–35% of women under 40 years of age [3]. It is also closely linked to fertility issues, appearing in approximately one-third of women assessed for infertility.

Fortunately, adenomyosis can be treated. Treatment options include pain relievers, hormonal therapies, minimally invasive procedures, and surgery, allowing most women to experience significant relief.

Does Adenomyosis Always Need Treatment?

No, adenomyosis is not cancerous. It is a benign condition, and treatment depends on the symptoms experienced, not just the diagnosis. Some women might have adenomyosis show up on a scan but do not feel any different. In these situations, it is perfectly fine to monitor your condition and observe how you feel over time.

When symptoms begin to affect your daily routine, it is time to consider treatment. Heavy bleeding that causes anaemia can leave you feeling worn out and breathless. Pain that interrupts work, sleep, or personal life is another sign to consider seeking help. If adenomyosis makes it difficult to get pregnant, it is a good reason to explore treatment options.

Adenomyosis is linked to oestrogen; therefore, symptoms usually ease up naturally after menopause because oestrogen levels drop. For women nearing menopause who can handle the symptoms, this natural decrease might lead them to choose a more conservative treatment instead of opting for something aggressive.

The aim of treatment is not just to respond to what a scan shows. It is about easing the symptoms that are important to you while considering your age, plans to have children, and your personal preferences.

How Is Adenomyosis Treated?

Treatment is categorised into three groups: 

• Medications for managing pain and bleeding 
• Hormonal therapies to address misplaced tissue
• Procedures or surgery for cases that do not respond to medication use. 

Women often start with the mildest treatments for adenomyosis and only consider stronger options if necessary. It is important to note that no medication can completely cure adenomyosis; the only way to fully resolve it is by removing the uterus. However, many treatments are available that can effectively manage symptoms for extended periods.

Medications for Adenomyosis

• Nonsteroidal anti-inflammatory drugs (NSAIDs).

Over-the-counter pain relievers, such as ibuprofen and naproxen, are often tried first. They reduce period pain and can lessen menstrual blood loss by lowering prostaglandin levels, which are the chemicals driving cramping and bleeding. NSAIDs work best for symptoms and are an option for women trying to conceive since they do not interfere with ovulation or pregnancy.

• Tranexamic acid.

This non-hormonal medicine, taken during menstruation, reduces heavy bleeding. It stabilises blood clots in the uterine lining, and studies show it reduces menstrual blood loss more effectively than NSAIDs. Because it targets bleeding, it is sometimes combined with an NSAID [1].

These medications treat symptoms rather than the underlying tissue; therefore, they are best suited for women with milder disease or those who prefer to avoid hormones. When pain and bleeding are significant, hormonal therapy is the next step in treatment.

Hormonal Treatments for Adenomyosis

Adenomyosis is affected by oestrogen; therefore, treatments that lessen the impact of oestrogen on the uterus are essential. Hormonal therapy is the main choice for women who do not plan to become pregnant. It helps reduce the size of the uterus and ease pain and bleeding.

• Levonorgestrel-releasing intrauterine system (LNG-IUS/hormonal IUD)

A small T-shaped device in the uterus releases a low dose of the hormone levonorgestrel (approximately 20 micrograms daily). It thins the uterine lining and lowers local oestrogen levels, thereby reducing bleeding and pain. The hormonal Intrauterine Device (IUD) is considered the most researched and effective option for adenomyosis symptoms, with quality-of-life improvements similar to those after hysterectomy.

• Combined oral contraceptives (the pill)

Birth control pills containing oestrogen and progestin reduce menstrual flow and thin the uterine lining. They can be taken continuously to skip the periods. Reviews suggest that they are less effective than hormonal IUD or dienogest for pain and heavy bleeding, but remain suitable for many women.

• Dienogest

Dienogest, a daily progestin-only pill, is used to treat adenomyosis. A 2024 meta-analysis showed that it reduced pain the most. A placebo-controlled trial found that it lowered pain scores, improved the quality of life, and was well tolerated. Irregular spotting in the first month is a common side effect.

• GnRH agonists and antagonists

GnRH medicines lower ovarian estrogen, causing a menopause-like state that reduces the uterus size and stops bleeding. GnRH agonists like leuprolide are second-line treatments, used before surgery or to transition to menopause. Low oestrogen levels can lead to hot flashes and weaker bones; therefore, it is advised to use supplemental hormones for more than six months. 

Oral GnRH antagonists, such as relugolix and linzagolix, offer several advantages [1,2,3,4,5].When choosing between options, your doctor will consider the intensity of your symptoms, interest in birth control, ability to manage side effects, and plans regarding pregnancy.

Surgery for Adenomyosis

When medications and hormonal therapies do not relieve symptoms, or if the condition worsens, it might be necessary to consider procedures or surgery. Options include techniques that keep the uterus intact and those that involve removing it entirely.

• Hysterectomy

Hysterectomy is the only definitive treatment for adenomyosis because it removes the affected tissue. This surgery is most suitable for women who have completed their family sizes and seek a permanent solution after other treatments have not worked. The ovaries are usually left in place to help avoid early menopause. However, this procedure requires a recovery period and means that future pregnancies are not possible.

• Adenomyomectomy

Women who wish to keep their ability to have children can have adenomyosis removed while keeping the uterus intact. Adenomyomectomy is easier if the condition is confined to one area rather than spread throughout the uterine wall. When the uterine wall is reconstructed, there is a risk of rupture in a future pregnancy, so careful monitoring is needed.

• Uterine Artery Embolisation

Uterine Artery Embolisation is a procedure whereby the blood vessels supplying the adenomyosis are blocked, causing the tissue to shrink. It avoids major surgery and keeps the uterus intact, making it a choice for women who want to avoid a hysterectomy.

• Ablation techniques: HIFU and radiofrequency

High-Intensity Focused Ultrasound (HIFU) uses sound waves, and radiofrequency ablation uses heat to destroy adenomyotic tissue without removing the uterus. Endometrial ablation works well when the disease is limited to the endometrium. These less aggressive methods broaden choices between medication and surgery.

How Doctors Choose the Right Treatment for Adenomyosis

There is no single "best" treatment for adenomyosis; the best option is the one that suits your symptoms and lifestyle. Care should be personalised, as there is no universal treatment plan. Doctors usually consider the following five criteria:

• Your main symptom

When experiencing heavy bleeding, pain, or a combination of both, initial treatment options may vary. For instance, the hormonal IUD and tranexamic acid are particularly effective for managing bleeding, whereas dienogest is particularly beneficial for alleviating pain.

• Whether you want to become pregnant

In many cases, this is the key factor. Hormonal therapies are known to prevent pregnancy, so women who wish to conceive are generally treated with NSAIDs or may undergo surgery aimed at enhancing fertility.

• Your age and how close you are to menopause

Symptoms naturally ease after menopause, which may favour non-invasive management for women nearing that stage.

• Severity and extent of disease

Focal adenomyosis may be removable surgically, while diffuse adenomyosis may respond better to medication or hysterectomy.

• Your preferences and tolerance for side effects

How you feel about hormones, devices, surgery, and recovery time all matter [1,3,6].

Treatment usually starts with the simplest option. If symptoms persist, more advanced treatments are considered. This decision is made together, with your needs given as much weight as the clinical findings.

Lifestyle Changes to Help Manage Adenomyosis Symptoms

While lifestyle changes cannot cure adenomyosis or undo the changes in the uterine wall, they can still be beneficial. These changes are not a replacement for medical treatment when symptoms are severe. However, they can support your well-being and enhance your daily life alongside medical care.

• A heating pad or warm bath can relax the uterine muscle and ease cramping, while light activity like walking or yoga may reduce pain perception and stress.
• A diet rich in fruits, vegetables, whole grains, and omega-3 fats and lighter on processed foods helps you feel better, though it supports rather than replaces treatment.
• If heavy bleeding has left you iron-deficient, iron-rich foods such as pumpkin leaves, chicken or beef liver, and supplements guided by your doctor can help restore your energy levels.
• Adequate sleep, relaxation techniques, and mental-health support can make symptoms more manageable.

Can Adenomyosis Return After Treatment?

It depends on the treatment. A hysterectomy completely removes the uterus, so adenomyosis cannot return. This is why it is seen as the only cure.When treatments that preserve the uterus are used, symptoms can come back. Medications and hormonal therapies manage adenomyosis but do not cure it, so symptoms often return once treatment is stopped. This is expected and not considered a failure.

Placing a hormonal IUD or using hormonal therapy after surgery can reduce the chance of recurrence by controlling tissue growth. Regular follow-up is important to catch any recurrence early.

Reasons to See a Doctor

Consider talking to a healthcare provider if you notice any of the following:

• Experiencing heavy menstrual periods so intense that you need to change a pad or tampon every hour or two, pass large clots, or require changes during the night.
• Menstrual cramps or pelvic pain that are so severe they interfere with work, school, sleep, or daily activities.
• Pain during sexual intercourse or constant pelvic pressure.
• Symptoms of anaemia due to heavy bleeding, such as ongoing fatigue, weakness, dizziness, or shortness of breath.
• Difficulty getting pregnant or experiencing repeated pregnancy loss [1,2].

Conclusion

Adenomyosis can be tough to deal with, especially after being told for years that painful periods are just part of life. But the good news is that it's a recognised condition with plenty of treatment options available. From painkillers and hormonal IUDs to specific medications like dienogest, and even minimally invasive procedures or surgery, there are many ways for women to find relief. Treatment is a team effort, and it's important to consider your symptoms, pregnancy plans, and personal preferences. With the right approach, managing adenomyosis can become easier.

Frequently Asked Questions About Adenomyosis Treatment

1. Is adenomyosis the same as endometriosis?

No, though they are related and often occur together. In endometriosis, endometrial-like tissue grows outside the uterus; in adenomyosis, it grows within the muscular wall of the uterus itself..

2. Can I get pregnant if I have adenomyosis?

Yes. Adenomyosis can make conception more challenging and is more common among women with infertility, but many women conceive and carry healthy pregnancies. 

3. Do I need a hysterectomy to treat adenomyosis?

Not usually. A hysterectomy is the only definitive cure, but it is one option among many and is typically reserved for severe cases or after other treatments have failed. 

4. Will adenomyosis go away on its own?

Symptoms commonly improve after menopause because adenomyosis is driven by estrogen, which declines at that stage. 

5. Which treatment is the most effective?

There is no single best treatment for everyone. The hormonal IUD is the best-studied and among the most effective for symptoms, and dienogest is especially strong for pain, but the right choice depends on your symptoms, age, and pregnancy plans.

References

1. Moawad, G.; Youssef, Y.; Fruscalzo, A.; Faysal, H.; Kheil, M.; Pirtea, et al. The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review. J. Clin. Med. 2023, 12, 6130. https://doi.org/10.3390/jcm12196130 Available from: https://www.mdpi.com/2077-0383/12/19/6130

2. Vercellini, P.; Buffo, C.; Bandini, V.; Cipriani, S.; Chiaffarino, F.; Viganò, P.; et al. Prevalence of Adenomyosis in Symptomatic Adolescents and Young Women: A Systematic Review and Meta-Analysis. F&S Rev. 2025, 6, 100083. https://doi.org/10.1016/j.xfnr.2024.100083 Available from: https://www.fertstertreviews.org/article/S2666-5719(24)00040-9/fulltext 
3. Galati, G.; Ruggiero, G.; Grobberio, A.; Capri, O.; Pietrangeli, D.; Recine, N.; et al. The Role of Different Medical Therapies in the Management of Adenomyosis: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 3302. https://doi.org/10.3390/jcm13113302 Available from: https://www.mdpi.com/2077-0383/13/11/3302 

4. Dason, E.S.; Maxim, M.; Sanders, A.; Papillon-Smith, J.; Ng, D.; Chan, C.; et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J. Obstet. Gynaecol. Can. 2023, 45, 417–429.e1. https://doi.org/10.1016/j.jogc.2023.04.008 Available from: https://www.jogc.com/article/S1701-2163(23)00307-9/abstract 

5. Zhang, B.; Shi, J.; Gu, Z.; Wu, Y.; Li, X.; Zhang, C.; et al. The Role of Different LNG-IUS Therapies in the Management of Adenomyosis: A Systematic Review and Meta-Analysis. Reprod. Biol. Endocrinol. 2025, 23, 23. https://doi.org/10.1186/s12958-025-01349-4 Available from: https://link.springer.com/article/10.1186/s12958-025-01349-4

6. Sharara, F.I.; Kheil, M.H.; Feki, A.; Rahman, S.; Klebanoff, J.S.; Ayoubi, J.M.; et al. Current and Prospective Treatment of Adenomyosis. J. Clin. Med. 2021, 10, 3410. https://doi.org/10.3390/jcm10153410 Available from: https://www.mdpi.com/2077-0383/10/15/3410 

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published July 31, 2026