Adenomyosis vs. Endometriosis: Why Knowing the Difference Could Change Your Health

🙌🏼 An Interview with Dr. Ken Sinervo

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April is Adenomyosis Awareness Month, and yet this condition remains largely overlooked—even by many healthcare providers. In a recent Fempower Health podcast interview, I spoke with Dr. Ken Sinervo, Medical Director at the Center for Endometriosis Care, to break down what adenomyosis is, how it differs from endometriosis, and what patients need to know about symptoms, diagnosis, fertility, and treatment.

This post summarizes the key takeaways from our conversation, with a focus on helping women advocate for proper care.

What Is Adenomyosis?

Adenomyosis is a chronic gynecologic condition in which tissue similar to the uterine lining (endometrium) grows into the muscular wall of the uterus (myometrium). This causes the uterus to function like a “bruised muscle,” triggering inflammation, pain, and abnormal bleeding.

Adenomyosis vs. Endometriosis: What’s the Difference?

Both conditions involve endometrial-like tissue growing where it shouldn’t—but where that tissue grows is the key difference:

Symptoms of Adenomyosis: What to Look For

Many symptoms of adenomyosis overlap with endometriosis, but certain signs are more specific. According to Dr. Sinervo, women with adenomyosis often report:

• Heavy or prolonged menstrual bleeding

• Painful periods that worsen over time

• Uterine tenderness during pelvic exams

• Chronic cramping (even outside menstruation)

• Back pain or discomfort that radiates from the uterus

• Pain during or after sex (can last days)

• Increased urinary urgency or bowel pressure

• Infertility or repeated miscarriage

Endometriosis, by contrast, may also include:

• Diarrhea or constipation during periods

• Pain with bowel movements

• Cyclical fatigue or immune issues

• Endo belly/bloating

Why Is Adenomyosis So Hard to Diagnose?

One reason adenomyosis is underdiagnosed is that its symptoms mimic other conditions like fibroids or endometriosis. Another is that many gynecologists aren’t trained to look for it—or assume it only occurs in older women.

But Dr. Sinervo says research now shows adenomyosis can affect teens and young adults, especially those with a history of:

• Cesarean sections

• D&Cs

• Uterine trauma

• Fibroids

How Is Adenomyosis Diagnosed?

There’s no single test, but diagnosis usually involves:

• Transvaginal ultrasound (to assess uterine wall thickness and structure)

• MRI (especially effective just before menstruation)

• Pelvic exam (looking for uterine tenderness and enlargement)

Adenomyosis can’t be confirmed without pathology after hysterectomy, but specialists can make a highly accurate clinical diagnosis using imaging and symptoms.

Can You Treat Adenomyosis Without a Hysterectomy?

Yes, but it depends on your goals—especially whether you want to preserve fertility.

Non-Surgical Treatment Options for Adenomyosis

• Progesterone IUDs (e.g., Mirena or Liletta) – 50% of patients see improvement, but it may take 6–12 months.

• Hormonal medications (e.g., norethindrone or compounded danazol suppositories)

• Anti-inflammatory diet and lifestyle support

• Pelvic floor physical therapy

• Pre-sacral neurectomy – A nerve-blocking surgery that offers temporary relief in some cases

When Is Hysterectomy Necessary for Adenomyosis?

If pain remains uncontrolled and fertility is no longer a goal, hysterectomy is the only definitive cure for adenomyosis.

Dr. Sinervo emphasizes:

• Most of the hysterectomies he performs are due to adenomyosis—not severe endometriosis.

• Only 5% of his endometriosis patients need hysterectomy for that condition alone.

• Many patients do not regret hysterectomy once all other options are exhausted.

How Does Adenomyosis Impact Fertility?

Adenomyosis can:

• Impair embryo implantation

• Increase miscarriage risk

• Raise chances of preterm labor or abnormal bleeding during pregnancy

Some fertility specialists use long-term Lupron therapy prior to IVF to suppress inflammation. However, success rates vary, and Dr. Sinervo says patients with both adenomyosis and endometriosis often benefit from laparoscopic excision of endo before proceeding with fertility treatments.

How to Advocate for Yourself if You Suspect Adenomyosis

If you’re experiencing chronic pelvic pain, heavy periods, or fertility struggles—especially if endometriosis has already been ruled in or out—ask your doctor:

• “Could adenomyosis be contributing to my symptoms?”

• “Can we do an ultrasound or MRI to investigate?”

• “Are there non-hysterectomy options we can try first?”

And if your concerns are dismissed? Get a second opinion.

🎧 Listen to the Full Episode

→ Adenomyosis Explained with Dr. Ken Sinervo (Fempower Health Podcast)

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References

1. Cleveland Clinic. (2022). Adenomyosis vs. endometriosis: What's the difference? Retrieved from https://my.clevelandclinic.org/health/diseases/22363-adenomyosis

2. Endometriosis.org. (n.d.). Adenomyosis. Retrieved from https://endometriosis.org/resources/articles/adenomyosis/

3. Mayo Clinic. (2023). Adenomyosis: Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138

4. American College of Obstetricians and Gynecologists. (2021). Management of Endometriosis (Practice Bulletin No. 218). Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/12/management-of-endometriosis

5. NIH National Library of Medicine. (2018). Adenomyosis: mechanisms and pathogenesis. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30513174/

6. Fempower Health (2024) Interview with Dr Ken Sinervo: Adenomyosis Uncovered: Symptoms, Diagnosis, and Treatment. https://www.fempower-health.com/post/adenomyosis-symptoms-diagnosis-treatment-dr-ken-sinervo