Endometriosis vs Adenomyosis – What Is the Difference?

Women’s reproductive health issues can often be tricky to diagnose. There are many different conditions that can create the same types of symptoms, and it is not unusual for a woman to have two different conditions present at the same time.

Two conditions that often cause confusion are endometriosis and adenomyosis because their origin is similar. Today we are going to take a closer look at both of these conditions and hopefully create a better understanding of each.

Can Endometriosis Be Mistaken for Adenomyosis?

These two conditions can be misdiagnosed interchangeably because they both involve endometrial cells ending up in the wrong location and the way they develop is very similar. It is also possible for a woman to suffer from both endometriosis and adenomyosis at the same time.

What Causes Endometriosis and Adenomyosis?

The endometrium is the inner lining of the uterus and the one that “builds up” preparing for a pregnancy and then “sheds” each month during a woman’s menstrual cycle in the absence of conception. This lining is composed of gland-like cells that are meant to remain together along the surface of the endometrium. Sometimes, however, these cells go rogue and grow either into the muscular wall of the uterus or start growing outside of the uterus altogether.

When these rogue gland-like cells begin to invade and trespass into an unauthorized territory, it is the location of these territories that delineates which condition is present.

Where Do Endometrial Cells Grow to Cause Endometriosis and Adenomyosis?

When these cells that are supposed to remain inside the lining of the uterus trespass into other locations they become problematic. When these rogue cells begin to grow outside of the uterus and attach themselves to the ovaries, bladder, or intestines or start growing on the wall of the pelvic cavity, the condition is known as endometriosis.

When these rogue cells bury themselves and grow deep inside the muscular walls of the uterus, the condition is known as adenomyosis.

How Do Endometrial Cells Spread?

How these rogue gland-like cells spread from the endometrium into other locations within the body is still the subject of much debate in the medical community but there are some different theories. Adenomyosis, for example, is most often seen in women in their 40s who have had multiple pregnancies, however, the process of how the endometrial cells grow into the uterine wall is not clear.

Much more research is needed to determine the cause so a cure and treatments can be perfected. Some of the most popular theories are:

1. Retrograde Menstruation Theory

Instead of the uterine lining being totally shed through the cervix and vagina during a woman’s menstrual cycle, the blood and glandular waste being shed are pushed out through the fallopian tubes onto the ovaries, into the pelvic cavity, and onto the other organs outside of the uterus.

With no exit point with which to be discarded, the tissue latches on and continues to build up and shed (bleed) along with the lining inside the uterus every month. This can cause inflammation, cramping, bleeding, and infertility.

2. The Vascular or Lymphatic System Theory

This theory suggests that the glandular cells normally located within the endometrium can get swept away inside of blood or lymphatic vessels and transported to other locations within the body.

Some women have monthly nosebleeds or cough up blood during their cycle, and some even have tiny strokes each month. This theory would provide a plausible explanation of why in rare instances endometrial tissue would be located in the nose, lungs, or brain.

Other Theories believe the condition is a result of an abnormality in the development of the female reproductive system, genetics and family history, dysfunction of the uterine contraction system, hormone imbalances, etc.

What Are The Symptoms of Endometriosis vs Adenomyosis?

One of the reasons these conditions are so tricky to identify is because the symptoms they produce are almost identical to those produced by many other female reproductive health conditions including pelvic pain and pressure, heavy menstrual bleeding, and cramping.

One of the differences between adenomyosis and endometriosis is the timing in which women experience pain and symptoms. Women with adenomyosis usually experience symptoms around the time of their menstrual cycle, while women with endometriosis experience pain not only around their cycle but also can have pain with bowel movements, urination, and during other times of the month.

Symptoms of Endometriosis and Adenomyosis Comparison Chart

Endometriosis Symptoms Shared Symptoms Adenomyosis Symptoms
  • Pain during bowel movements;
  • Pain during urination;
  • Pelvic pain;
  • Fatigue;
  • Nausea;
  • Diarrhea during the menstrual cycle.
  • Painful periods;
  • Pain during sexual intercourse.
  • Chronic pelvic pain;
  • Abnormal bleeding and prolonged periods;
  • Infertility;
  • Enlarged uterus.

Endometriosis vs Adenomyosis vs Fibroids

Sometimes, adenomyosis is incorrectly mistaken for the presence of uterine fibroids which are benign growths that can occur in or on the uterus. Historically, some of the treatments offered to patients who suffered from fibroids were used to treat women with adenomyosis and they developed complications.

  • Both adenomyosis and uterine fibroids can cause pelvic pain, pressure, heavy bleeding, and an enlarged uterus;
  • Adenomyosis usually is experienced by women who are over 40 years old and 80% of these women have a history of childbirth;
  • Uterine fibroids normally affect younger women of childbearing age and can cause infertility or complications with pregnancy.

While adenomyosis and uterine fibroids, which cause similar symptoms, can sometimes be mistaken for each other on ultrasound, MRI imaging provides a clear way to tell these conditions apart. However, in some instances, small areas of adenomyosis may still look like small fibroids. Endometriosis is easier to distinguish from uterine fibroids because its location is completely outside the uterus.

MRI imaging also provides a more clear view of endometriosis than ultrasound, however, some small areas of endometriosis can be invisible with imaging and need to be diagnosed with a minor surgery called diagnostic laparoscopy.

Learn how to identify symptoms of fibroids, adenomyosis, and endometriosis
Symptoms of uterine fibroids vs. adenomyosis vs. endometriosis

Treatment for Endometriosis

Unfortunately, there is not a cure for endometriosis at this time and it is difficult to treat. The goal is usually to mitigate symptoms so that it does not inhibit a woman’s everyday life. Prescription medication, oral contraceptives, and laparoscopic surgery to remove the rouge tissue are usually first-line treatments.

Often a hysterectomy is performed to eliminate some symptoms and prevent further growth or spread of endometriosis but it does not guarantee success because endometriosis can spread outside of the uterus. In these cases, an excision surgery can be performed.

Treatment for Fibroids and Adenomyosis Without Surgery

Most women who are suffering symptoms of adenomyosis or uterine fibroids can be treated with a non-surgical procedure called uterine artery embolization (UAE) better known as uterine fibroid embolization (UFE).

UFE is an outpatient procedure that takes about 45 minutes to complete and the patient is discharged home the same day with only one bandaid. The recovery is usually about 5A7 days which is a fraction of the time associated with surgical treatments.

UFE works by cutting off the critical blood supply needed by the fibroids or rouge endometrial tissue to survive. When they lose their blood supply they can no longer grow or survive. 90% of women find permanent relief of their fibroid symptoms as a result of uterine fibroid embolization. For adenomyosis patients, the success rate of the procedure is approximately 70-80%.

Did You Know?

The embolization procedure performed to treat adenomyosis is called uterine artery embolization or UAE. The embolization procedure performed for fibroid treatment is called uterine fibroid embolization or UFE. The methodology is the same, even though the names are slightly different.

If you are suffering from symptoms related to adenomyosis or uterine fibroids, contact the Atlanta Fibroid Center today. Interventional radiologists Dr. John Lipman and Dr. Ermentrout have over 27 years of experience in performing the UFE procedure and are experts in the field. They have helped 9,000+ women gain relief from their painful symptoms and get their lives back, all without sacrificing their uterus. Contact us today!

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