Adenomyosis: When Uterine Lining Grows Into the Muscle

Table of Contents

1. How Adenomyosis Differs From Endometriosis and Fibroids
2. How Common It Is Depends on Who Is Counted
3. Heavy Bleeding, Pain and Silent Cases
4. The Proposed Causes
5. How Ultrasound and Magnetic Resonance Imaging Find It
6. Fertility and Pregnancy Findings
7. Hormonal Options: The Levonorgestrel Device and Dienogest
8. Gonadotropin-Releasing Hormone Drugs
9. Uterine Artery Embolization
10. High-Intensity Focused Ultrasound
11. Surgery: Removing the Tissue or the Uterus
12. Traditional and Herbal Reports
13. What Is Not Known
14. Key Research Papers
15. Connections
16. Featured Videos

How Adenomyosis Differs From Endometriosis and Fibroids

The three conditions are often confused because they can cause similar symptoms and can occur in the same person. The main difference is where the abnormal tissue sits and what it is made of.

• Adenomyosis: lining-type tissue inside the muscle wall of the uterus. It can be spread through the wall (diffuse) or gathered in one area (focal), and imaging can tell these patterns apart (Chapron 2020).
• Endometriosis: lining-like tissue outside the uterus, for example on the ovaries or the lining of the pelvis. Adenomyosis was once called "endometriosis interna." A 2020 review argued that it is not simply endometriosis of the uterus (Guo 2020), and a 2017 review of the molecular research described the two as independent diseases that share some genetic changes and inflammatory signals (Vannuccini 2017).
• Uterine fibroids: separate, usually rounded, benign growths made mainly of muscle cells, not lining tissue. Fibroids and adenomyosis commonly occur in the same uterus, and it can be hard to say which one is causing which symptom (Taran 2013). Both depend on estrogen and progesterone (Ferrero 2026). A large fibroid can also throw an ultrasound shadow that partly or completely hides adenomyosis (Donnez 2026).

How often the conditions overlap depends on how closely anyone looks. In a Washington State health-system study based on diagnosis codes, 18.0% of women with an adenomyosis diagnosis also had an endometriosis code and 47.6% had a fibroid code (Yu 2020). In a single-center study of 182 women having keyhole hysterectomy for suspected adenomyosis, where surgeons trained in endometriosis inspected the pelvic lining closely and removed visible lesions, endometriosis was confirmed in 73.6% (Woodward 2026). The first study counted what was written in medical records. The second counted what surgeons found while looking for it, in a group already having surgery.

How Common It Is Depends on Who Is Counted

Published figures run from about 1% to nearly 50%, and much of the gap comes from who was studied and how the diagnosis was made.

• General population: a 2025 meta-analysis of 59 adenomyosis studies put the global prevalence at 1% (95% confidence interval 0–2%) (Wang 2025).
• One United States health system: among 333,693 women aged 16–60 followed from 2006 to 2015, new diagnoses ran at 28.9 per 10,000 woman-years. Prevalence in 2015 was 0.8% overall and 1.5% at ages 41–45. Those were counts of recorded diagnoses, and chart review confirmed 78.5% of the coded new cases it could check (Yu 2020).
• People with symptoms: the same 2025 meta-analysis found 41–49% among people with gynecologic symptoms (Wang 2025).
• People with infertility: the same analysis gave 31%, with a very wide confidence interval of 10–58% (Wang 2025). A separate 2023 meta-analysis of 21 studies and 25,600 women with subfertility found 10% with adenomyosis alone (95% confidence interval 6–15%), with 19% in Australian studies against 5% in Asian ones (Mishra 2023).
• Reproductive age, by expert estimate: a 2026 review's plain-language summary gives 20–30% of patients of reproductive age and describes rising rates in younger patients (Donnez 2026). That sits far above the 1% population figure, a gap that shows how unsettled the number remains.

The United States study found that new diagnoses peaked at ages 41–45 (69.1 per 10,000 woman-years in 2008) and that rates were higher in Black women than in white women (highest yearly rates 44.6 and 27.9 per 10,000 woman-years). Overall yearly rates ranged from a high of 30.6 in 2007 to a low of 24.4 in 2014 (Yu 2020).

Even the microscope does not settle it. When disease is limited, pathologists often disagree with one another, which a major 2020 review linked to "extreme variations" in reported prevalence (Chapron 2020).

Heavy Bleeding, Pain and Silent Cases

The symptoms described most often are heavy menstrual bleeding, painful periods (dysmenorrhea), ongoing pelvic pain, pain during sex and difficulty conceiving (Taran 2013; Chapron 2020; Yu 2020). In the United States cohort, 90.8% of women had one of these symptom codes recorded. Some people have adenomyosis found on a scan with no symptoms (Chapron 2020), and none of these symptoms is specific to it.

Trial enrollment figures give a sense of what severe disease looks like. Across the eight studies in a 2026 meta-analysis, women started with an average period-pain score of about 6.8 out of 10 and an average uterine volume of about 153 cubic centimeters (Su 2026). Two dienogest studies treated anemia in any woman who had it before she started the study drug (Osuga 2017, both studies). In the United States study, 37.6% of women used chronic pain medicines and 82.0% had a hysterectomy (Yu 2020).

Blood loss over months can lead to iron-deficiency anemia. Bleeding heavy enough to bring on fainting, a racing heart, chest pain or breathlessness is a pattern hospitals treat as urgent.

A Cancer Finding That Depends on Timing

A Dutch pathology registry study compared 129,862 women with tissue-proven endometriosis or adenomyosis with 132,700 women on the same registry who had a mole (nevus) examined. Endometrial cancer reports were more common in the first group (age-adjusted odds ratio 2.58). When the first year of follow-up was left out, the odds ratio fell to 0.76, meaning the cancers were most often found at the same time as the benign diagnosis. In around 20% of the cancer cases, the cancer was not recognized until after hysterectomy, and 35% of those women had no earlier biopsy or curettage (Hermens 2021). The study combined the two conditions, so it does not give a figure for adenomyosis alone.

The Proposed Causes

No cause has been established. A 2018 review stated plainly that the origin and development of the disease have not been worked out (García-Solares 2018). These are the leading explanations, each one a proposal and not a proof.

• Invagination, or injury and repair. The most common theory holds that tissue injury and the repair that follows let the deep layer of the lining push down into the muscle (García-Solares 2018).
• Metaplasia. The alternative holds that the lesions form where they are found, from leftover embryonic tissue or from adult stem cells that change type, with no need for the lining to invade (García-Solares 2018).
• Disruption of the lining-muscle border. A 2020 review called both main theories hard to test and limited in what they predict, and proposed that medical procedures which injure the border between lining and muscle may produce adenomyosis through poor oxygen supply at the wound and displaced lining cells. It is a hypothesis about procedure-related cases (Guo 2020).
• Cell movement. Studies in human lesions and in mice point to epithelial-mesenchymal transition, a process in which fixed cells gain the ability to move. A baboon model suggested that groups of cells may migrate together in later stages (García-Solares 2018).
• Hormone and inflammation signals. Reviews describe sex-hormone receptor changes, inflammatory molecules, tissue-remodeling enzymes, growth factors and nerve and blood vessel growth signals in adenomyosis tissue (Vannuccini 2017; Chapron 2020). These are thought to help explain the pain and bleeding, though finding a signal in diseased tissue does not show that it started the disease.

How Ultrasound and Magnetic Resonance Imaging Find It

The two main tests are ultrasound through the vagina (a transvaginal scan) and magnetic resonance imaging (MRI). Neither involves surgery. The accuracy studies compared scan results with the uterus examined under a microscope after hysterectomy, so they mainly measure performance in people who were already having that operation.

• Head-to-head comparison. A 2023 meta-analysis pooled six studies and 595 women who had both tests. Transvaginal ultrasound picked up 75% of women with adenomyosis and correctly cleared 81% of women without it. For magnetic resonance imaging the figures were 69% and 80%. The difference was not statistically significant (Alcázar 2023).
• A wider pool. A 2020 meta-analysis of ten studies gave 78% and 88% for magnetic resonance imaging, 74% and 76% for two-dimensional ultrasound, and 84% and 84% for three-dimensional ultrasound. Its authors called the tests comparable and proposed ultrasound first, with magnetic resonance imaging second if ultrasound is inconclusive (Tellum 2020).
• Individual features. A 2021 meta-analysis looked at single measurements on magnetic resonance imaging. Maximum thickness of the junctional zone, the inner band of muscle next to the lining, detected 71.6% of cases and correctly cleared 85.5% of those without. Small cysts in the muscle wall detected fewer, 59.6%, but cleared 96.1%, so when seen they were a stronger pointer. Many of those studies had an unclear or high risk of bias, and the authors found that few had linked scan appearance to how women actually felt (Rees 2021).

The two tests do not see the same thing. A 2023 review reported that the junctional zone measures thicker on magnetic resonance imaging than on ultrasound, so a number from one test cannot simply be applied to the other. The same review argued that a thickened zone may matter less than visible breaks in it, where lining tissue interrupts the band, which appear as lines and buds on ultrasound or as bright spots on magnetic resonance imaging (Harmsen 2023). Microscope criteria were built around severe disease and may miss early stages. Formal diagnostic criteria are still not universally agreed (Chapron 2020).

The 2023 Canadian guideline lists both transvaginal ultrasound and magnetic resonance imaging as diagnostic options (Dason 2023).

Fertility and Pregnancy Findings

Conceiving and In Vitro Fertilization

The research disagrees on how much adenomyosis itself lowers the chance of a baby. A 2022 meta-analysis found lower live-birth rates in women with adenomyosis having in vitro fertilization (odds ratio 0.59, 95% confidence interval 0.37–0.92) and higher miscarriage rates (odds ratio 2.11) (Cozzolino 2022). An earlier meta-analysis of 11 comparative studies reached a similar conclusion (Younes 2017).

However, a prospective study of 1,228 women starting in vitro fertilization at one group of clinics found worse results at first glance and no significant difference in most outcomes, including live birth, after adjusting for age, smoking and other factors. Age is linked both with adenomyosis and with lower fertility, which could account for part of the earlier findings. Its authors noted that the study was underpowered and that the adjustment could be hiding a real effect (Higgins 2021).

Pre-treatment is also unsettled. The 2017 meta-analysis suggested that long-term gonadotropin-releasing hormone agonist pre-treatment could help (Younes 2017). The 2022 meta-analysis, with only three studies on that question, found no increase in in vitro fertilization success (Cozzolino 2022), and a 2025 analysis before frozen embryo transfer found a comparable live-birth rate with and without the shots (odds ratio 1.19, 95% confidence interval 0.69–2.06) (Steinmann 2025). The overlap page covers protocols in more detail, and Female Infertility covers the wider subject.

Pregnancy

The largest pooled analysis, of 39 studies with 25,564 women with adenomyosis, found higher risks for several outcomes. Besides preeclampsia (relative risk 2.24), miscarriage (1.61), heavy bleeding after birth (1.73) and a misplaced placenta (3.26), it reported babies small for gestational age (1.79), low birth weight (2.29), a baby lying in an unusual position (1.95), and the waters breaking early before term (2.87). It found no significant difference for gestational diabetes, uterine rupture, fetal growth restriction, stillbirth or newborn intensive care admission. The authors rated the certainty of this evidence as low to very low, and these were associations from observational studies, not proof of cause (Etrusco 2026).

Hormonal Options: The Levonorgestrel Device and Dienogest

No drug is specifically approved for adenomyosis, according to a 2026 review (Donnez 2026), and the authors of one trial wrote that neither of the two main options below had been approved for it (Choudhury 2024). The 2023 Canadian guideline lists anti-inflammatory painkillers, tranexamic acid, combined contraceptive pills, the levonorgestrel intrauterine device, dienogest, other progestins and gonadotropin-releasing hormone drugs among medical options (Dason 2023). A 2023 review found anti-inflammatory painkillers and tranexamic acid give limited support for mild symptoms, and that combined pills may be less effective than progestins (Etrusco 2023).

Levonorgestrel Intrauterine Device

This is a small device that releases a progestin hormone inside the uterus.

• Against hysterectomy. A randomized trial enrolled 86 women, of whom 75 continued. Over one year, hemoglobin rose with the device to levels comparable with those after hysterectomy. Quality-of-life scores improved in all five domains with the device and in three of five with hysterectomy (Ozdegirmenci 2011).
• Against dienogest. In an open-label trial in India that recruited 74 women, pain scores fell by about the same amount at 12 weeks: from 6.41 to 3.41 with the device and from 6.41 to 3.12 with dienogest. Lighter bleeding was more common with the device (90% against 77.2%), while overall quality of life improved more with dienogest. Hot flushes were reported in the dienogest group, and neither group had major adverse reactions (Choudhury 2024). A 2026 meta-analysis of eight studies and 527 patients found no significant difference at 3 and 6 months. One study reached 12 months, with the device shrinking the uterus more and dienogest easing period pain more (Su 2026).
• The device can shift. Among 99 women with adenomyosis in a retrospective study, the risk of the device moving down or being expelled rose above a uterine width of 5.4 centimeters, by 112% for each added centimeter (hazard ratio 2.12) (Lin 2025, device study).

Dienogest

Dienogest is a progestin tablet.

• Against placebo. A double-blind Japanese trial of 67 patients gave dienogest 2 mg daily or placebo for 16 weeks. Pain scores fell significantly more with dienogest. Almost everyone on dienogest had irregular bleeding, and one patient had mild anemia. The authors limited their conclusion to adenomyosis without severe uterine enlargement or severe anemia (Osuga 2017, placebo trial).
• Over one year. In a 52-week study in which all 130 patients were given 2 mg daily, irregular bleeding was reported in 96.9% and hot flushes in 7.7%, with no serious adverse events. Pain scores fell by a mean 3.8 points by the end (Osuga 2017, long-term study).
• Pooled. A meta-analysis of 14 studies and 637 patients found period-pain scores fell by a mean of 6 points on a 10-point scale, with larger drops in women who started with worse pain or took it longer. The authors called for larger comparative trials (Lin 2025, dienogest analysis).
• Against the combined pill. In a randomized trial in Egypt, pain fell in both groups after 6 months, more with dienogest, and uterine volume also fell. The dienogest group reported more side effects (Hassanin 2021).

Bleeding is a central tradeoff here. Irregular bleeding was reported in nearly everyone taking dienogest in the first two studies above, in a condition where heavy bleeding is itself a main complaint.

Gonadotropin-Releasing Hormone Drugs

Gonadotropin-releasing hormone (GnRH) drugs lower the ovaries' hormone output. They come in two kinds. Agonists are usually long-acting injections, and antagonists are newer tablets. Their main side effects follow from the low estrogen they produce.

Agonists

A 2023 review reported that agonists manage symptoms effectively but bring on menopausal symptoms with prolonged use (Etrusco 2023). In a study of 70 women with adenomyosis and endometriosis, randomly divided into two groups, the trial gave triptorelin 3.75 mg by injection either every 6 weeks for 4 doses or every 4 weeks for 6 doses. Pain relief was reported in all of them at 6 months, uterine volume fell by 37.6% and 39.2%, and estrogen levels dropped to the postmenopausal range (Kang 2010). The study had no group without the drug.

Antagonists

Elagolix, relugolix and linzagolix have been studied in adenomyosis, but the evidence is early. A 2026 review drew on two after-the-fact analyses of randomized trials, one retrospective study and one prospective study. No dedicated randomized controlled trial was among them, and the authors said such trials are needed (Donnez 2026). The review noted that the tablets do not cause the initial flare of worsening symptoms seen with agonist injections, and that their effect reverses quickly.

The prospective study was a pilot of eight women aged 37–45. The trial gave linzagolix 200 mg daily for 12 weeks, then 100 mg daily for 12 more. Uterine volume fell by 55% at 12 weeks, and was 32% below the starting volume at 24 weeks after the dose was lowered. Pain improved. Bone density dropped by 2.4% at the spine, 1.3% at the femoral neck and 4.1% at the total hip by 24 weeks, and hot flushes affected six of eight women in the first 12 weeks (Donnez 2021).

A separate 2026 review described antagonists as suppressing the condition and not curing it, with symptoms often returning after they are stopped, and said their role in adenomyosis looks promising on limited evidence (Ferrero 2026).

Uterine Artery Embolization

In this procedure, a specialist passes a thin tube through an artery into the vessels feeding the uterus and blocks them with small particles, cutting blood supply to the affected tissue. It is also an established treatment for uterine fibroids (Dessouky 2019).

• Against dienogest. A 2026 single-center randomized trial of 60 women with scan-confirmed adenomyosis compared embolization with dienogest 2 mg daily. At 6 months, chronic pelvic pain had fully resolved in 93.3% against 66.7%, and heavy bleeding in 90.0% against 56.7%. The uterus shrank by 17.6% against 7.3% (Refaat 2026). This is short-term data from one center, and the abstract reports no long-term results.
• Against hysterectomy. The Dutch QUESTA study began as a randomized trial and was converted to a study in which women chose their treatment (51 hysterectomy, 50 embolization). Quality of life improved with both at one year. The study could not show that embolization was as good as hysterectomy within its preset margin, and it could not show that it was worse. Pain improved more after hysterectomy, and 95% were satisfied after hysterectomy against 73% after embolization. The authors called embolization a valid less-invasive alternative and hysterectomy the treatment of choice for those seeking a definite solution (Trommelen 2025).
• Pooled observational data. A 2026 systematic review of 22 cohort studies and 1,701 women whose disease had resisted other treatment found 76.4% had significant symptom improvement at short and mid-term follow-up. Complications were mostly minor, major events were uncommon, and no deaths were reported. The review excluded case reports and did not include randomized comparisons (Ini' 2026).

The studies above do not establish what embolization does to later fertility, and the QUESTA comparison involved women who were eligible for hysterectomy. A 2013 review had described the data on embolization as the strongest among the newer techniques while noting that none of those studies were randomized or controlled (Taran 2013). The 2026 trial above begins to fill that gap.

High-Intensity Focused Ultrasound

High-intensity focused ultrasound (HIFU) aims focused sound waves through the skin to heat and destroy a target area of tissue, with no incision. Much of the published experience comes from uncontrolled case series.

• Symptoms. A 2020 meta-analysis found reduced uterine volume at 12 months, reduced period pain at 3 and 12 months, and better quality of life at 6 and 12 months. Adverse reactions were reported in 55.9% of patients. The authors wrote that no randomized trials compared it with other conservative treatments at that time, and that their pooled results rested on few, non-uniform studies (Marques 2020).
• Who is selected. A 2017 review reported strict selection criteria: pelvic endometriosis, bowel stuck to the uterus, or an abdominal scar wider than 10 mm were listed as making patients unsuitable (Zhang 2017). Pelvic endometriosis is common in surgical series of adenomyosis, as described above, so the results may apply only to a selected group.
• Pregnancy. One meta-analysis of 10 studies and 557 patients gave a pooled pregnancy rate of 53.4% and live-birth rate of 35.2%, and called the evidence "very weak" (Chen 2024). A later one of 15 studies and 3,730 patients gave a pregnancy rate of 54.6% and a live-birth rate of 75.8% counted among those who became pregnant, and said randomized trials are needed (Liang 2026). The second live-birth figure counts only women who became pregnant, so the two are not directly comparable.
• With a hormone drug. A 2021 meta-analysis of nine studies and 766 patients found more shrinkage, less pain and lower recurrence (relative risk 0.28) when a gonadotropin-releasing hormone agonist was added. The authors urged caution, as there were few studies and most were in Chinese (Pang 2021).
• Ovarian reserve. A 2026 meta-analysis of 10 studies and 667 women with fibroids or adenomyosis found a small fall in anti-Müllerian hormone, a blood marker of remaining egg supply (0.12 ng/mL), and no significant change in follicle count. The data were too thin for a figure specific to adenomyosis, and uncontrolled before-and-after studies cannot show the treatment caused the change (Karadeniz 2026).

Surgery: Removing the Tissue or the Uterus

Hysterectomy

Removing the uterus removes the disease site and ends the possibility of pregnancy. In the United States cohort, 82.0% of women had hysterectomies (Yu 2020). Adenomyosis has long been diagnosed from the removed uterus (Chapron 2020), so some of those diagnoses may have followed the surgery and not led to it. The randomized trial against the levonorgestrel device and the QUESTA study against embolization are described above.

Uterus-Sparing Surgery (Adenomyomectomy)

This operation cuts out or reduces the affected part of the muscle wall and rebuilds the wall. Comparative studies are scarce, and a 2014 review called well-designed ones urgently needed (Grimbizis 2014). A 2020 meta-analysis called for comparisons with other treatment options (Mikos 2020).

• Symptoms. A 2014 review of 64 studies and 1,049 patients reported that after complete excision, period pain was reduced in 82.0% and heavy bleeding controlled in 68.8%, with a pregnancy rate of 60.5%. After partial excision, those figures were 81.8%, 50.0% and 46.9% (Grimbizis 2014). A 2020 meta-analysis of 19 studies and 1,843 patients also found improvement in pain and bleeding with both complete and partial excision (Mikos 2020).
• Pregnancy. A 2023 meta-analysis of 13 studies with 795 women wishing to conceive found pregnancy, miscarriage and live-birth rates of 40%, 21% and 70% after excision, and 51%, 22% and 71% after non-excisional techniques such as high-intensity focused ultrasound. The differences were not statistically significant (Jiang 2023).
• Pregnancy risks afterward. In a single-center retrospective study comparing 18 pregnancies after adenomyomectomy with 105 pregnancies in women with adenomyosis, all 18 were delivered by cesarean. One had a uterine rupture at 30 weeks, and placenta accreta spectrum, in which the placenta attaches too deeply, occurred in 50% against 0%. Average blood loss at cesarean was 1,748 mL against 1,330 mL. On the other side, rupture of membranes before labor, preeclampsia and small babies were less common after surgery, at 0% against 12%, 12% and 15% (Sayama 2023).
• A case of rupture. A 2007 case report described a woman who became pregnant one month after laparoscopic adenomyomectomy. At 28 weeks she had sudden severe abdominal pain and an abnormal fetal heart rate, and an emergency cesarean found the uterus torn at the surgical site. Mother and baby did well. The authors named earlier surgery and a short gap before pregnancy as possible risk factors (Morimatsu 2007). Sudden severe abdominal pain in a pregnancy after uterine surgery is a sign hospitals treat as urgent.

A 2013 review reported that older minimally invasive procedures, including removing or burning the uterine lining, have had limited success, based on small case series with short follow-up (Taran 2013).

Traditional and Herbal Reports

These reports come from traditional medicine practice and research, and are labelled as such.

• Herbal medicine after high-intensity focused ultrasound. A 2025 meta-analysis of 14 randomized trials and 1,259 patients reported greater reductions in uterine volume, lesion volume and period pain when herbal medicine followed the procedure than with the procedure alone. The authors called for higher-quality trials with long-term follow-up (Kim 2025).
• A traditional Chinese decoction compared with drugs. A study of 210 patients in three groups of 70 compared a traditional Chinese herbal decoction, dienogest, and goserelin plus a levonorgestrel device. The authors concluded that the decoction was markedly effective for pain and the drug combination for bleeding. The abstract does not state that groups were randomized (Liang 2025).
• Traditional Korean medicine. A single case report described a 40-year-old woman with suspected adenomyosis given a modified form of the formula Bojungikgi-tang for 12 months, with pain falling from 7–8 to 1–2 out of 10 and hemoglobin returning to normal (Park 2025).
• Acupuncture and moxibustion. Chinese clinical journals describe treatment plans built on traditional theory, using "blood stasis" as the underlying pattern and choosing acupuncture points according to the phase of the cycle (Xia 2024; Hou 2017). These articles describe the traditional reasoning and do not report trial results.

No clinical trial of a diet for adenomyosis turned up in the searches behind this page, so none is reported here. Related pages on other conditions are Dysmenorrhea and Endometriosis Diet and Lifestyle.

What Is Not Known

• The true frequency. Estimates still range from 1% to 20–30% of women of reproductive age, because the criteria and the populations differ (Wang 2025; Donnez 2026).
• The cause. Each main theory has known gaps (Guo 2020), and it is unclear whether one process explains every form of the disease.
• Whether scan appearance predicts symptoms. Few studies have tied scan findings to how women actually feel (Rees 2021).
• Whether adenomyosis itself reduces fertility, or whether age and other factors explain part of the difference (Higgins 2021).
• Which treatment does best over the long term. Most trials are small, single-center and short. A 2023 review called for research on guidelines, fertility outcomes and the long-term effects of therapies (Etrusco 2023).
• How long benefits last after stopping a hormonal treatment, and how much bone is lost with longer use of gonadotropin-releasing hormone drugs in this condition (Ferrero 2026).
• Whether any uterus-sparing procedure improves the chance of a live birth compared with no procedure. The pooled pregnancy figures above do not come from randomized comparisons with no treatment.

Key Research Papers

1. Woodward KT, Burnett TL, Khan Z, Cole KC, VanBuren WM, Schoolmeester JK, Green IC, Cope AG. Prevalence of concomitant endometriosis in patients undergoing laparoscopic hysterectomy with suspected adenomyosis: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2026;323:115126. PubMed PMID: 42066596
2. Yu O, Schulze-Rath R, Grafton J, Hansen K, Scholes D, Reed SD. Adenomyosis incidence, prevalence and treatment: United States population-based study 2006-2015. Am J Obstet Gynecol. 2020;223(1):94.e1-94.e10. PubMed PMID: 31954156
3. Wang MH, Chen JH, Qi XY, Li ZX, Huang Y. Global prevalence of adenomyosis and endometriosis: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2025;23(1):148. PubMed PMID: 41257733
4. Mishra I, Melo P, Easter C, Sephton V, Dhillon-Smith R, Coomarasamy A. Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;62(1):23-41. PubMed PMID: 36647238
5. Donnez J, Donnez O, Taylor HS, Petraglia F, Horne AW, Becker CM, Renner SP, Rius M, Bestel E, Stratopoulou CA, Dolmans MM. Role of oral gonadotropin-releasing hormone antagonists in the management of uterine adenomyosis: a narrative review. Reprod Fertil. 2026;7(3). PubMed PMID: 42599074
6. Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, Gordts S, Guo SW, Just PA, Noël JC, Pistofidis G, Van den Bosch T, Petraglia F. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. PubMed PMID: 32097456
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8. García-Solares J, Donnez J, Donnez O, Dolmans MM. Pathogenesis of uterine adenomyosis: invagination or metaplasia?. Fertil Steril. 2018;109(3):371-379. PubMed PMID: 29566849
9. Guo SW. The Pathogenesis of Adenomyosis vis-à-vis Endometriosis. J Clin Med. 2020;9(2). PubMed PMID: 32050720
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11. Ferrero S, Gazzo I, Perrone U, Olcese F, Ottonello S, Rosato FP, Vellone VG, Barra F. GnRH antagonists for the treatment of fibroids and adenomyosis, current evidence and future perspectives. Expert Opin Pharmacother. 2026;27(11):1163-1178. PubMed PMID: 42360331
12. Alcázar JL, Vara J, Usandizaga C, Ajossa S, Pascual MÁ, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis. Int J Gynaecol Obstet. 2023;161(2):397-405. PubMed PMID: 36461921
13. Tellum T, Nygaard S, Lieng M. Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging. J Minim Invasive Gynecol. 2020;27(2):408-418.e3. PubMed PMID: 31712162
14. Rees CO, Nederend J, Mischi M, van Vliet HAAM, Schoot BC. Objective measures of adenomyosis on MRI and their diagnostic accuracy-a systematic review & meta-analysis. Acta Obstet Gynecol Scand. 2021;100(8):1377-1391. PubMed PMID: 33682087
15. Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, Thomassin-Naggara I, Van den Bosch T, Huirne JAF. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. Ultrasound Obstet Gynecol. 2023;62(1):42-60. PubMed PMID: 36370446
16. Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, Sobel M. Guideline No. 437: Diagnosis and Management of Adenomyosis. J Obstet Gynaecol Can. 2023;45(6):417-429.e1. PubMed PMID: 37244746
17. Hermens M, van Altena AM, Velthuis I, van de Laar DCM, Bulten J, van Vliet HAAM, Siebers AG, Bekkers RLM. Endometrial Cancer Incidence in Endometriosis and Adenomyosis. Cancers (Basel). 2021;13(18). PubMed PMID: 34572823
18. Cozzolino M, Tartaglia S, Pellegrini L, Troiano G, Rizzo G, Petraglia F. The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis. Reprod Sci. 2022;29(11):3177-3193. PubMed PMID: 34981458
19. Younes G, Tulandi T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertil Steril. 2017;108(3):483-490.e3. PubMed PMID: 28865548
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PubMed Topic Searches

1. PubMed: Adenomyosis treatment
2. PubMed: Adenomyosis and the levonorgestrel intrauterine device
3. PubMed: Adenomyosis and dienogest
4. PubMed: Uterine artery embolization for adenomyosis
5. PubMed: High-intensity focused ultrasound for adenomyosis
6. PubMed: Gonadotropin-releasing hormone antagonists for adenomyosis
7. PubMed: Adenomyomectomy and pregnancy
8. PubMed: Adenomyosis epidemiology

Connections

• Reproductive Medicine
• Endometriosis and Adenomyosis
• Endometriosis
• Uterine Fibroids
• Dysmenorrhea
• Hormonal Therapy Options
• Female Infertility
• Iron-Deficiency Anemia
• Postpartum Hemorrhage

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