Adenomyosis is often mistaken for endometriosis, delaying diagnosis for years: Doctors explain diagnosis and treatment options

Dubai: For many women, heavy bleeding, severe cramps and persistent pelvic pain are simply written off as a normal part of having periods. But for those living with adenomyosis, a condition in which tissue similar to the uterine lining grows into the muscular wall of the uterus, these symptoms are often a sign of something that deserves proper diagnosis and treatment.

UAE-based gynaecologists explain why the condition is so frequently missed, and what women should know.

A condition that hides in plain sight

According to Dr Fathima Thasneem, Specialist Obstetrician and Gynaecologist at Medcare Women and Children Hospital, many women spend years assuming their symptoms are simply part of having a period. "They may plan their lives around heavy bleeding, carry extra clothes just in case, miss work because of pain, or constantly feel exhausted without realising there is an underlying medical reason," she said.

Dr Nilesha Chitre, Specialist in Obstetrics and Gynaecology at RAK Hospital, explained that the condition causes the uterus to become enlarged, inflamed and more sensitive to hormonal changes, which can lead to heavy bleeding, severe cramps, chronic pelvic pain, bloating, lower back pain, pain during intercourse and fatigue linked to anaemia.

Dr Suma Thomas, Specialist Gynaecologist at Aster Clinic, Discovery Gardens, noted that because symptoms like bloating and heavy bleeding overlap with other conditions, diagnosis is often delayed. "Due to the common symptoms like bloating and excessive bleeding, it could be thought of as IBS or a fibroid and gets delayed in diagnosis," she said, adding that the condition is often seen in women who have had multiple deliveries and can remain asymptomatic for years.

Adenomyosis versus endometriosis

The two conditions are frequently confused, but the difference largely comes down to location. Dr Thasneem explained that in adenomyosis, tissue grows within the muscular wall of the uterus itself, while in endometriosis, similar tissue grows outside the uterus, affecting areas such as the ovaries, fallopian tubes, bladder or bowel.

Dr Thomas offered a simple way to think about the relationship between the two. "Adenomyosis is endometriosis affecting the uterus," she said, noting that a patient can have adenomyosis alongside ovarian involvement, commonly known as chocolate cysts, at the same time.

Dr Chitre confirmed that having both conditions simultaneously is far more common than many realise. "It is not uncommon for patients referred to specialist endometriosis clinics to be diagnosed with both adenomyosis and endometriosis," she said, adding that when the two coexist, symptoms tend to be more severe and management often requires a multidisciplinary approach.

When to see a doctor

All three doctors agreed that pain severe enough to disrupt daily life should never be dismissed as normal. Dr Thasneem said that if periods are painful enough to cancel plans, miss work, avoid exercise or spend days in bed, it is worth speaking to a doctor, alongside warning signs like heavy bleeding, pelvic pain outside of menstruation, bloating, pain during intercourse and worsening symptoms over time.

Dr Thomas added that women whose pain and bleeding persist despite first-line treatments like anti-inflammatory medication should seek further evaluation, particularly if bowel symptoms follow a cyclical pattern in relation to their period, which could point toward endometriosis.

Diagnosis and treatment

Diagnosis typically begins with a detailed history and pelvic examination, but imaging plays a central role in confirming the condition. Dr Chitre said a high-quality transvaginal ultrasound is usually the first step, with MRI used in more complex cases to distinguish adenomyosis from fibroids or other pelvic conditions. Dr Thomas echoed this, noting that ultrasound, MRI and blood tests help confirm a diagnosis once a doctor suspects the condition based on history and physical examination.

Treatment approaches differ depending on a woman's age, symptoms and fertility goals. For women planning a pregnancy, doctors generally focus on managing symptoms through hormonal therapies, including progesterone-based treatment, contraceptive pills or hormone-releasing intrauterine devices such as Mirena.

Dr Thomas noted that ultrasound or MRI-guided procedures and laparoscopic options may also be considered depending on symptom severity and fertility requirements.

For women who have completed their families and continue to experience severe symptoms unresponsive to conservative treatment, hysterectomy remains the definitive option. Dr Thomas described it as a measure typically reserved for "the elderly with severe pain," while Dr Chitre noted that it offers the highest likelihood of long-term relief in select cases.

All three doctors stressed that women do not need to simply live with the condition. With improved imaging and growing awareness, earlier diagnosis is increasingly possible, helping women regain control over their daily lives without symptoms holding them back.