Adenomyosis and endometriosis are two of the most common gynecological disorders that affect women.1,2 Both conditions are associated with significant morbidity and a poor quality of life, particularly if their diagnosis occurs late.2,3 In fact, both adenomyosis and endometriosis are known to result in infertility in many patients.4-6
These and other significant similarities between the two conditions are often a source of great confusion for people. In this article, we discuss the differences between adenomyosis and endometriosis in the context of biology, symptoms, and risk factors.
Adenomyosis vs Endometriosis: Difference
Both adenomyosis and endometriosis are characterized by the presence of an ectopic endometrium.1 The difference between the two conditions lies in the location of the ectopic endometrium.1 In endometriosis, the endometrial glands and stroma are present outside the uterus.7,8 On the other hand, in adenomyosis, they are located within the myometrium, that is, the muscular wall of the uterus.1,8
Adenomyosis and Endometriosis: Symptoms
Although a third of adenomyosis cases are asymptomatic8, symptomatic patients generally suffer from severe dysmenorrhea, pelvic pain, abnormal uterine bleeding, and anemia.1,4 Endometriosis, too, presents itself with pelvic pain and dysmenorrhea, among other symptoms, such as painful bowel movements and painful intercourse.3
Adenomyosis and Endometriosis: Prevalence
Endometriosis is prevalent in over 10% of the women in their reproductive age, while adenomyosis has a greater prevalence of 20-35%.9,10 Notably, adenomyosis and endometriosis are also known to co-occur, although the prevalence of this co-occurrence is not clear.8
It is important to note that adenomyosis and endometriosis have different clinical profiles.8 Endometriosis patients often tend to have a close relative (mother or sister) who has experienced the condition herself.4 Importantly, endometriosis patients are typically younger than adenomyosis patients, and are more likely to have never been pregnant before.8,9 Meanwhile, adenomyosis patients are generally older and have a history of pregnancy.8 Specifically, adenomyosis shows the highest prevalence among women in the 35-50 years age group.9,10
The incidence of endometriosis is greater among women who experienced their first period at a younger age (early menarche).1 Shorter length of the menstrual cycle is another risk factor for endometriosis.1 Interestingly, both early menarche and short menstrual cycles are also known risk factors for adenomyosis.8
Adenomyosis and Endometriosis: Severity
Both adenomyosis and endometriosis have several subtypes, depending on the exact location of the ectopic endometrium. There are three different categories of endometriosis, namely, ovarian endometriosis, peritoneal endometriosis, and deep infiltrating endometriosis.3,7 Meanwhile, adenomyosis has four main subtypes – focal adenomyosis located in the outer myometrium (FAOM), intrinsic adenomyosis, extrinsic adenomyosis, and adenomyosis externa.2
Adenomyosis and Endometriosis: Treatment Options
Both surgical (laparoscopic surgery) and non-surgical (hormone therapies) treatment options are available for endometriosis.11 Similarly, adenomyosis has several treatment options, including surgical (such as hysterectomy) and non-surgical.12 Minimally invasive techniques such as uterine artery embolization (UAE) are increasingly popular for adenomyosis treatment.12
Adenomyosis and endometriosis are both significant causes of morbidity and infertility among women of reproductive age. While they share important similarities, their anatomical locations, clinical profiles, and prevalence differ vastly. A knowledge of these differences can help ease diagnosis and expedite treatment.
Adenomyosis Treatment – Uterine Arterial Embolization (UAE)
Uterine artery embolization, or UAE, is a non-surgical image-guided procedure that effectively treats adenomyosis (and fibroids) in one treatment. This is done by placing a tiny catheter into the uterine artery and blocking the blood flow to the abnormal lining using tiny beads.
Some of the UAE advantages include:
- No hospital stay
- No general anesthesia
- No stitches
- No blood loss
- No risk of hysterectomy
- No major scars
- No surgical risks
Why CVI?
Not all embolizations are the same. Uterine artery embolization may be offered by practitioners of varying levels of experience. An academic hospital will have doctors in training that will often place too many beads into the artery. Other practitioners may use products or suboptimal techniques that are outdated.
Our center specializes in embolizations and our staff is uniquely trained to care for these type of procedures, from the pre-op to the post-op period. Our specialist performs a high number of embolization for not only the uterus but also in other more high risk and complex organs, such as the kidney, liver, lung and others. Patients are often surprised how quick and simple the UAE procedure was for them, but this comes at the experience of our specialist who performs a variety of complex embolizations safely. This diversity of experience has resulted in our specialist to treat complex fibroid and adenomyosis cases safely and effectively.
Our specialist continually keeps up with the research to make sure that he brings the best and newest technology to our center. We are also always collecting feedback from patients and modifying how we provide care so that patients have the best level of experience.
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Request an appointment to meet with our specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each woman is an individual and should discuss the potential risks and benefits of fibroid embolization and other treatments with our doctor to decide which option is best for her.
Appointments are available via an online video telehealth platform or in person based on availability at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here.
- Guo SW. The pathogenesis of adenomyosis vis-à-vis endometriosis. Journal of Clinical Medicine. 2020; 9(2):485.
- Maruyama S, Imanaka S, Nagayasu M, Kimura M, Kobayashi H. Relationship between adenomyosis and endometriosis; Different phenotypes of a single disease?. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020; 253:191-7.
- Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Practice & Research Clinical Obstetrics & Gynaecology. 2014; 28(5):655-81.
- Ota H, Igarashi S, Hatazawa J, Tanaka T. Is adenomyosis an immune disease?. Human Reproduction Update. 1998; 4(4):360-7.
- Hashimoto A, Iriyama T, Sayama S, Tsuruga T, Kumasawa K, Nagamatsu T, Osuga Y, Fujii T. Impact of endometriosis and adenomyosis on pregnancy outcomes. Hypertension Research in Pregnancy. 2019: HRP2019-015.
- Szubert M, Koziróg E, Olszak O, Krygier-Kurz K, Kazmierczak J, Wilczynski J. Adenomyosis and infertility—review of medical and surgical approaches. International Journal of Environmental Research and Public Health. 2021; 18(3):1235.
- Alimi Y, Iwanaga J, Loukas M, Tubbs RS. The clinical anatomy of endometriosis: a review. Cureus. 2018; 10(9).
