Source: NICE, RCOG, Fertility Guideline NG257
1 in 10
of women in the UK are estimated to have adenomyosis. Many cases remain undiagnosed.
Adenomyosis and Fertility
Understanding adenomyosis and its impact on your fertility
Adenomyosis is a benign condition affecting the womb (uterus), where tissue similar to the lining of the womb grows into the muscular wall of the uterus.
The tissue responds to the hormonal changes of the menstrual cycle. This can cause inflammation and enlargement of the uterus and may lead to symptoms including painful periods, heavy menstrual bleeding, pelvic pain and pain during sex.
Some women have no symptoms at all and may only discover they have adenomyosis during an ultrasound scan or fertility investigations.
Adenomyosis is more commonly diagnosed in women over 30, although it can affect anyone who has periods. Improvements in ultrasound and better awareness of adenomyosis mean that more women are receiving the diagnosis, including those who may have been missed previously
At Manchester Fertility, we understand that a diagnosis of adenomyosis can be particularly concerning if you're trying to conceive. Our fertility specialists can assess how adenomyosis may be affecting your fertility and discuss the most appropriate treatment options for you.
Adenomyosis and Your Fertility
Adenomyosis does not necessarily mean that you will be unable to conceive.
Many women with adenomyosis become pregnant naturally. However, research has found an association between adenomyosis and reduced fertility, including lower pregnancy rates following assisted reproductive treatment and a higher risk of miscarriage.
The exact relationship between adenomyosis and infertility is complex. It can be influenced by factors such as your age, ovarian reserve, the extent and location of adenomyosis, whether you also have endometriosis or fibroids, and whether there are other male or female fertility factors.
Adenomyosis may affect fertility in several ways.
- Changes to the womb environment
Adenomyosis can cause inflammation within the uterine muscle. This may alter the environment in which an embryo needs to implant and develop.
- Changes to uterine contractions
The uterus normally undergoes subtle contractions during the menstrual cycle. Adenomyosis can alter the structure of the uterine muscle and may affect these contractions, potentially interfering with sperm transport or embryo implantation.
- Changes to the endometrium
Research suggests adenomyosis may affect the receptivity of the endometrium – the lining of the womb – making implantation more difficult in some patients.
- Co-existing conditions
Adenomyosis can occur alongside other gynaecological conditions, particularly endometriosis and fibroids. These conditions can themselves affect fertility, making it important to understand the complete picture rather than looking at adenomyosis in isolation.
Adenomyosis Facts and Figures
Around 25%
of female infertility is caused by ovulation disorders. Ovulation disorders are one of the leading causes of infertility
1 in 7
of couples in the UK experience infertility during their reproductive years
What Causes Adenomyosis?
The exact cause of adenomyosis remains unknown, but researchers believe several factors may contribute to its development.
Current theories include:
1
Growth of endometrial tissue into the uterine muscle
The most widely accepted theory suggests that cells from the uterine lining gradually invade the muscle wall, particularly following inflammation or injury.
2
Previous uterine surgery
Some evidence suggests that procedures such as:
- Caesarean section
- Removal of fibroids
- Dilation and curettage
may increase the likelihood of adenomyosis by disrupting the boundary between the uterine lining and muscle.
3
Hormonal influences
Adenomyosis is dependent on oestrogen. Symptoms often improve after menopause when oestrogen levels naturally decline.
4
Inflammation
Chronic inflammation within the uterus may encourage the development and progression of adenomyosis.
5
Genetic factors
Although research is ongoing, genetics may play a role in increasing susceptibility to the condition.
Symptoms of Adenomyosis
Some women with adenomyosis have no symptoms. Others may experience symptoms that can significantly affect their quality of life.
Common symptoms include:
- Heavy or prolonged periods
- Painful periods
- Pelvic pain
- Lower abdominal pain or pressure
- Pain during sex
- Bloating or a feeling of fullness
- Abnormal bleeding between periods
Heavy menstrual bleeding can sometimes lead to iron-deficiency anaemia, which may cause tiredness, weakness or shortness of breath.
For some women, difficulty conceiving may be the reason adenomyosis is discovered.
The severity of symptoms does not necessarily indicate how much adenomyosis is present. Some women with relatively mild symptoms may have significant changes on imaging, while others with more extensive adenomyosis may experience few symptoms.
Can I Get Pregnant Naturally With Adenomyosis?
Yes. It is possible to become pregnant naturally with adenomyosis.
Some women with adenomyosis conceive without fertility treatment, particularly when there are no additional fertility problems.
However, adenomyosis may make conception more difficult for some women, and the impact can vary significantly between individuals.
Your age is also an important consideration. Female fertility naturally declines with age, particularly due to changes in egg number and quality. If you have adenomyosis and are also approaching your late 30s or 40s, it may be helpful to seek fertility advice sooner rather than waiting.
If you have been trying to conceive without success, a fertility assessment can help identify whether adenomyosis is likely to be contributing to your difficulties or whether there are other factors that need to be considered.
How is Adenomyosis Diagnosed?
Adenomyosis is diagnosed by your GP through a series of tests and checks, including:
1
Pelvic ultrasound
A specialist transvaginal ultrasound is often the first investigation.
Typical findings may include:
- Thickened uterine muscle
- Enlarged uterus
- Small cysts within the muscle wall
- Asymmetrical thickening
2
Medical history
Your consultant will discuss:
- Menstrual symptoms
- Pain patterns
- Fertility history
- Previous pregnancies
- Previous uterine surgery
- Family history
3
MRI scan
If additional information is required, MRI provides highly detailed images of the uterus and can help confirm the diagnosis or assess disease severity.
How is Adenomyosis Treated?
Treatment depends on your symptoms and whether you are currently trying to become pregnant.
For women who are not currently trying to conceive, hormonal treatments may be used to manage symptoms such as heavy or painful periods.
If you're trying to have a baby, treatment decisions are different because some hormonal treatments prevent pregnancy while you are taking them.
Depending on your individual circumstances, your fertility specialist may discuss:
- Trying to conceive naturally
- Treatment to manage symptoms before attempting pregnancy
- IVF - In-Vitro Fertilisation
- Medical treatment before embryo transfer
- Surgical treatment in selected circumstances
- There is no one-size-fits-all treatment for adenomyosis.
Your consultant will consider your age, fertility history, symptoms, ovarian reserve, the appearance of your uterus and your family-building plans before recommending a treatment approach.
What Happens if I Have Adenomyosis and I'm Trying to Conceive?
If you've been diagnosed with adenomyosis and want to have a baby, the next step is to understand how the condition may be affecting your individual fertility.
Manchester Fertility offer fertility assessments for women individually or as part of a heterosexual and same-sex couple. Each test aims to give a complete and thorough assessment of your current fertility health, which includes:
1
Reviewing your medical and fertility history
We'll discuss your periods, symptoms, previous pregnancies, fertility treatment and any other relevant medical conditions.
2
Assessing your uterus
A transvaginal ultrasound can help assess the structure of your uterus and identify features associated with adenomyosis.
3
Assessing your ovarian reserve
Tests such as AMH and antral follicle count may be used to assess your ovarian reserve and help build a complete picture of your fertility.
4
Assessing other fertility factors
Where appropriate, your assessment may also consider ovulation, the fallopian tubes and sperm quality.
5
Creating your treatment plan
Once your results are available, your fertility consultant will discuss your options.
Book a Fertility Assessment
A fertility assessment involves a series of simple tests and a 50-minute consultation with a fertility consultant.
We will assess your current fertility status and provide insight into potential treatment options.
Our Fertility assessments are £465 for heterosexual couples and £365 for single females.
Book Now
Why Manchester Fertility?
Being diagnosed with adenomyosis can raise difficult questions about your chances of having a baby.
At Manchester Fertility, we take time to understand your individual circumstances rather than treating your diagnosis in isolation.
Our fertility specialists can assess your uterus, ovarian reserve and wider fertility health and explain how adenomyosis may be affecting your chances of conception.
We'll discuss your options clearly, including the potential benefits and limitations of fertility treatment, so you can make informed decisions about your next steps.
Your treatment plan will be tailored to your age, fertility history, symptoms and family-building goals.
Dr Alastair Duncan
Consultant Anaesthetist
Dr Anamika Rao is our Fertility Consultant with 20 years of experience in Obstetrics, Gynaecology, Infertility and Early pregnancy. She has completed her postgraduate training both from India and the UK and is a Fellow of Royal College of Obstetricians and Gynaecologists.
FAQs
Can you get pregnant naturally with adenomyosis?
Yes. Many women with adenomyosis become pregnant naturally. However, the condition can affect fertility for some women, so your individual circumstances should be assessed.
Does adenomyosis mean I am infertile?
No. A diagnosis of adenomyosis does not mean you are infertile. It may make conception more difficult for some women, but many women with adenomyosis become pregnant and have healthy babies.
Can IVF help with adenomyosis?
IVF may be an option for women with adenomyosis, particularly where there are additional fertility factors or difficulty conceiving naturally. Your consultant will assess whether IVF is appropriate and discuss how your treatment may be tailored.
Does adenomyosis increase the risk of miscarriage?
Some research suggests that adenomyosis may increase the risk of miscarriage, but many women with the condition have successful pregnancies. Your individual risk depends on several factors.
Can adenomyosis affect egg quality?
Adenomyosis primarily affects the uterus rather than the ovaries, so it is not generally considered a direct cause of reduced egg quality. Age remains one of the most important factors affecting egg quality.
Can adenomyosis cause low AMH?
Adenomyosis itself is not primarily a condition of the ovaries. However, adenomyosis can occur alongside other conditions, such as endometriosis, which may affect ovarian reserve. Your AMH result should therefore be interpreted alongside your wider fertility assessment.
Can adenomyosis be cured?
There is no single treatment that is guaranteed to permanently cure adenomyosis while preserving fertility. Treatment is usually focused on managing symptoms and, where appropriate, supporting fertility.
Should I have treatment for adenomyosis before trying for a baby?
Not necessarily. The best approach depends on your symptoms, age, fertility history and the extent of the adenomyosis. Your fertility specialist can advise whether treatment before trying to conceive or IVF is appropriate.
Can adenomyosis get worse with age?
Adenomyosis is influenced by reproductive hormones and may change over time. Symptoms can vary considerably between women. If you're concerned about worsening symptoms or fertility, a specialist assessment can help determine the most appropriate next step.
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