Adenomyosis and Fertility: Everything You Need to Know
Adenomyosis can affect your uterus, your cycle, your comfort — and your fertility. If you’ve been diagnosed (or suspect you may have it), understanding how it fits into your fertility path is an important first step.
Author
Tassia O’Callaghan
Reviewed by
Kayleigh Hartigan
15 min read
Condition spotlight:
- Adenomyosis is a condition where tissue similar to the womb lining grows into the muscle of the uterus, often causing pain, heavy periods, or fertility challenges. [1]
- It may affect up to 1 in 5 people seen in gynaecology clinics, including those in their 20s and 30s — but many cases go undiagnosed. [2,3]
- Symptoms can range from severe period pain and pelvic discomfort to no symptoms at all. [1,4,5,6]
- Adenomyosis has been linked to lower embryo implantation and pregnancy rates, even with IVF — but treatments can help improve outcomes. [4,5,6]
- Diagnosis usually involves a transvaginal ultrasound or MRI, though symptoms often overlap with other conditions like endometriosis. [1,4,5]
- There’s no cure, but hormone therapy, surgery, and personalised fertility treatment plans can support both symptom management and conception. [4,5,7]
What is adenomyosis?
Adenomyosis is a condition where tissue similar to the lining of your womb (the endometrium) starts growing into the muscular wall of the uterus. This misplaced tissue thickens, breaks down, and bleeds with each menstrual cycle — just like the endometrium does. But because it’s trapped inside the muscle, it can cause inflammation, swelling, and sometimes quite intense pain. [1]
Over time, this can lead to an enlarged, tender uterus, heavier periods, and persistent pelvic discomfort — although for some, it causes no noticeable symptoms at all.
Adenomyosis can affect anyone with a uterus who has periods. It’s more commonly diagnosed in people over the age of 30, but it can appear earlier — and often goes undetected for years. For many, it’s only discovered while investigating things like painful periods, difficulty getting pregnant, or symptoms that just don’t seem to match up with a textbook menstrual cycle. [8]
It’s important to know that adenomyosis is not the same as endometriosis, even though they’re often confused. Endometriosis involves similar tissue growing outside the uterus — on places like the ovaries or fallopian tubes — while adenomyosis happens inside the muscular wall of the womb. They can co-exist, and in fact share many symptoms, which is why your doctor may come across one while investigating the other. Still, they are distinct conditions and often need different treatment approaches. [8,9]
How rare is adenomyosis?
Adenomyosis isn’t rare — but for a long time, it’s been hidden in plain sight. Newer imaging methods like transvaginal ultrasound and MRI have made it easier to detect, and as a result, we’re learning that this condition is actually much more common than previously thought.
A prospective study of 985 women found that around 1 in 5 who attended a general gynaecology clinic had signs of adenomyosis on ultrasound — that’s about 21% of patients. But because those attending clinics often have symptoms, this figure might be higher than in the general population. Still, it challenges the old idea that adenomyosis is a rare condition affecting only women in their 40s who’ve already had children. [2,3]
What’s clearer now is that adenomyosis can affect people much earlier in life — including those in their 20s and 30s — and it may play a role in unexplained fertility issues. Some studies suggest it could be present in 1 in 10 women with subfertility. [10]
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What causes adenomyosis?
The exact cause of adenomyosis isn’t fully understood — but several theories help explain why it happens, and who might be more likely to develop it:
- Hormones play a role. Adenomyosis is oestrogen-sensitive, which is why symptoms often appear in your 30s or after pregnancy — and why they tend to settle post-menopause. [4,11]
- It may be triggered by uterine trauma. Childbirth, C-sections, or procedures like D&Cs could make it easier for the womb lining to grow into the muscle wall. [4,5]
- Smoking could increase the risk. Studies suggest smoking may affect hormone levels and immune function in a way that contributes to uterine inflammation and tissue changes. [5]
- Some are more genetically prone. There’s no single gene, but a family history of adenomyosis, endometriosis, or fibroids could increase your risk. [4,12]
- Inflammation and immune responses inside the uterus may make the environment more hostile to embryo implantation and early pregnancy. [4,5]
Adenomyosis may also develop gradually, with symptoms becoming noticeable only after coming off hormonal contraception or trying to conceive.
What are the symptoms of adenomyosis?
Adenomyosis can show up loudly — or barely make a sound. For some people, it causes heavy, painful periods and ongoing pelvic pain. For others, it goes unnoticed until they start trying to conceive and find that something isn’t quite adding up. [1,4,5,6]
Here are the more common symptoms of adenomyosis, and how they might show up:
- Painful periods (dysmenorrhoea): Cramping is common during menstruation, but adenomyosis pain is often deeper, more intense, and can radiate into your back or legs. It may feel like a dragging ache, stabbing pain, or constant pressure — and it might stop you from doing day-to-day things.
- Heavy bleeding (menorrhagia): You might bleed through pads or tampons quickly, need to change protection during the night, or experience clotting. This can lead to anaemia, which brings fatigue, weakness, and shortness of breath.
- Pelvic pain outside of your period: Chronic pelvic pain — even when you’re not menstruating — is a common sign. It may feel like a dull ache, sharp stabs, or a sense of “fullness” in the lower abdomen.
- Bloating or heaviness: The uterus can become enlarged due to adenomyosis, causing bloating or a sensation of fullness or pressure in your belly — sometimes mistaken for IBS or fibroids.
- Pain during sex (dyspareunia): Some people experience pain with penetration, especially deep penetration. This pain can be sharp or cramping and may linger afterwards.
- Spotting or bleeding between periods: You might notice unpredictable bleeding or brown discharge between periods, or after sex — a common reason people seek help from a GP or gynaecologist.
- No symptoms at all: Many people with adenomyosis have no obvious symptoms. In fact, it’s often diagnosed during fertility investigations, following a miscarriage, or when imaging is done for another reason.
Can adenomyosis affect fertility?
Potentially, yes — but it’s complicated and still very under-researched. Adenomyosis has been linked to lower implantation rates, higher miscarriage rates, and a reduced chance of success with IVF or ICSI. Researchers believe this may be down to the way adenomyosis changes the uterus on a structural and cellular level. [4,5,6]
Adenomyosis can make the uterus less welcoming for an embryo by causing inflammation, messing with hormone signals, and lowering important proteins needed for implantation (like integrins and LIF). Some studies have found that even when good-quality embryos are used, women with adenomyosis may still have lower pregnancy success — suggesting the uterus itself might be the issue. [4,5,6]
Some people with adenomyosis still conceive naturally, while others go on to have successful IVF after treatment. So while it may be a factor, it’s not always the full story.
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How is adenomyosis diagnosed?
Adenomyosis can be tricky to diagnose — symptoms often overlap with other conditions like fibroids or endometriosis, and not everyone has clear signs. Many people only discover they have it during fertility investigations.
If you’re experiencing symptoms like painful, heavy periods or ongoing pelvic discomfort, your first step is to see your GP. They might ask about your menstrual cycle and symptoms, check your abdomen for any swelling, and/or offer an internal examination (you can request a chaperone or bring someone with you).
From there, your GP can refer you to a gynaecologist, who may arrange further testing. The two main imaging tools used to look for adenomyosis are:
- Transvaginal ultrasound: This is the most common first-line test. It involves an internal ultrasound probe and can help spot features like a thickened uterine wall or unusual textures. If several signs of adenomyosis show up, it strengthens the case for diagnosis.
- MRI scan: If the ultrasound isn’t clear — or if you’re planning fertility treatment — an MRI may be used to get a more detailed view of the uterus, especially the “junctional zone” (the area where adenomyosis usually develops).
While scans can suggest adenomyosis, the only way to confirm it is with a tissue sample from the uterus — usually after surgery like a hysterectomy, which isn’t an option for people trying to conceive. So most diagnoses are made based on symptoms, imaging, and ruling out other conditions. [1,4,5]
New research from Tommy’s National Centre for Miscarriage Research suggests that around 1 in 10 women with reduced fertility have adenomyosis — but that figure might just be the tip of the iceberg. Many cases may be missed due to inconsistent diagnostic guidelines, especially if symptoms are mild. [10]
The good news? Awareness is growing — and that means better support and earlier diagnosis are possible. If you think something isn’t right, trust your instincts. Keep a record of your symptoms, ask for referrals, and don’t be afraid to advocate for yourself. You deserve answers — and the right care.
Can you treat adenomyosis?
There’s currently no cure for adenomyosis — but it can be managed, and treatment may help improve symptoms and fertility outcomes. What works best will depend on your age, symptoms, fertility goals, and how severe the condition is. [1,4,5]
If you’re not trying to get pregnant right now, treatment often focuses on reducing pain and heavy bleeding. Options include:
- Hormonal treatments like an intrauterine system (such as the Mirena coil), the progestogen-only pill, or GnRH agonists (which temporarily lower oestrogen levels).
- NSAIDs (like ibuprofen) or tranexamic acid to ease period pain and bleeding.
- Surgical options — (removal of the womb, which ends the possibility of carrying a pregnancy yourself) or endometrial ablation (removing the womb lining). While a hysterectomy rules out pregnancy, it doesn’t always mean the end of using your own eggs — surrogacy may still be an option. That said, it’s a major decision that will significantly shape the course of your fertility path.
While none of these options “cure” adenomyosis, many people find their symptoms become manageable — and some go on to conceive naturally or with fertility support.
What happens if adenomyosis is left untreated?
If left untreated, adenomyosis can lead to ongoing symptoms like severe period pain, heavy bleeding, pelvic discomfort, and pain during sex. These symptoms may worsen over time and affect daily life. For some, the condition remains silent. [1]
How to conceive with adenomyosis
If you’re trying to conceive, some treatments may improve your chances — though evidence is still emerging. These include:
- GnRH agonists before embryo transfer, especially in IVF — which may shrink lesions, reduce inflammation, and support implantation. [13]
- Conservative surgery (like adenomyomectomy) to remove adenomyotic tissue while preserving the uterus — though this isn’t suitable for everyone, is still considered relatively new, and carries some risks. [14]
- Frozen embryo transfer after GnRH downregulation — which has shown promise in improving pregnancy rates. [15]
Find the right clinic for you
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How does adenomyosis affect fertility treatment?
Adenomyosis can make assisted fertility treatment more complex — but not impossible.
While research is still ongoing, there’s growing evidence that adenomyosis may reduce the chances of success with treatments like IVF. It’s been linked with lower implantation rates, a higher risk of early miscarriage, and in some cases, a lower chance of live birth. This is thought to be due to how adenomyosis can affect the uterus — from disrupting normal contractions, to increasing inflammation, to lowering the levels of key implantation markers in the endometrial lining. [4,5,7]
That said, not everyone with adenomyosis will experience the same level of difficulty, and many people do go on to have successful outcomes through fertility treatment.
What we do know:
- Severity matters: Studies suggest that people with more severe forms of adenomyosis (i.e. more diagnostic features seen on scans) may have lower success rates with IVF than those with milder signs.
- Pre-treatment can help: Some clinics recommend medication (such as GnRH agonists) for a few months before IVF or egg retrieval. This can help to shrink adenomyotic tissue, reduce inflammation and potentially improve the chances of implantation.
- Frozen embryo transfers may offer better results: In certain cases, freezing embryos and transferring them after a course of hormone treatment can lead to higher success rates than fresh transfers.
- Egg and embryo quality aren’t always the issue: Even when high-quality embryos are used, people with adenomyosis can experience difficulties. This suggests the uterine environment itself plays a role.
- There’s no one-size-fits-all protocol: Management depends on the individual’s age, symptom severity, coexisting conditions (like endometriosis or fibroids), and whether they’ve experienced previous treatment failures.
If you’ve been diagnosed with adenomyosis or are undergoing fertility treatment and suspect it may be a factor, talk to your clinic about how your protocol can be tailored. Some clinics specialise in managing adenomyosis-related subfertility, and may offer a more personalised approach to improve your chances.
Should you freeze your eggs if you have adenomyosis?
Freezing your eggs can be a sensible option if you’ve been diagnosed with adenomyosis and want to preserve your fertility — particularly if you’re not ready to conceive yet, or are considering treatment that could affect your ability to carry a pregnancy. This can be especially valuable if a hysterectomy is needed before you’ve completed your family, as your frozen eggs could still be used with surrogacy in the future.
Current studies don’t suggest that adenomyosis directly affects egg quality, but it may make embryo implantation more difficult. Because symptoms can worsen with age, some people decide to freeze their eggs earlier — while their ovarian reserve is still stronger — to give themselves more flexibility in the future.
There’s also growing interest in whether a “freeze-all” IVF strategy — where embryos are created and frozen, then transferred in a later cycle — might be particularly helpful for people with adenomyosis. One study found that those who used this approach had higher live birth rates over time compared with fresh transfers. Researchers suggest this may be because the high oestrogen levels during stimulation can aggravate adenomyosis and reduce receptivity, and that giving the uterus time to recover could improve outcomes. Some clinics may also recommend a long-protocol IVF cycle with a period of down-regulation, an approach often used in endometriosis, to help reduce overstimulation and manage the impact of lesions linked to both conditions. [16,17]
That said, the evidence is still emerging, and more research is needed to confirm the long-term benefits of egg freezing specifically for adenomyosis. It’s also worth noting that the women who had better results with freeze-all transfers in the study tended to have a stronger ovarian reserve to begin with.
Where can I find more support on adenomyosis?
If you’re navigating an adenomyosis diagnosis — or suspect you may have it — you’re not alone, and support is out there. Whether you’re looking for trusted medical advice, peer support, or practical tips on managing symptoms, here are some good places to start:
- Endometriosis UK – Adenomyosis Hub: A reliable UK-based resource that now includes dedicated adenomyosis information, webinars, and support groups.
- Adenomyosis Advice Association: A global patient-led organisation sharing lived experiences, medical insights, and advocacy for better recognition and care.
- The Endometriosis Foundation: Offers accessible educational resources and a platform for raising awareness of adenomyosis and related conditions.
- Pelvic Pain Support Network: Focuses on all types of chronic pelvic pain, including adenomyosis, with helpful downloads and a free helpline.
- The Adeno Gang: A community-led initiative raising awareness of adenomyosis, offering support spaces, and campaigning for improved education and care.
- The Menstrual Health Project: A UK-based non-profit dedicated to tackling stigma around periods and menstrual health, with practical resources and advocacy for conditions like adenomyosis and endometriosis.
- NHS: While not all local services will have adenomyosis-specific pathways, your GP or gynaecologist may be able to offer referrals, prescribe treatment, or help coordinate care. Keep a record of your symptoms to bring to appointments.
- Your fertility clinic or gynaecologist: If you’re in treatment or undergoing testing, ask your care team whether they have experience with adenomyosis and can refer you to a specialist or clinic with a dedicated focus on uterine conditions.
Summary
Adenomyosis is complex, underdiagnosed, and often misunderstood — especially when it comes to fertility. For some, it causes painful periods and obvious symptoms. For others, it quietly disrupts the uterus in ways that only become clear during fertility testing or after early pregnancy loss.
While there’s no cure, there are ways to manage it — from hormone treatments to surgical options, and tailored fertility protocols that take adenomyosis into account. Some people conceive naturally. Others find success with IVF, especially when using approaches like frozen embryo transfer or pre-treatment to calm inflammation.
The challenge? Getting the right diagnosis, the right care, and the right plan — all of which can feel overwhelming when you’re already navigating TTC. That’s where Seen Fertility comes in. Whether you’re looking for evidence-based guidance, trying to work out your next step, or searching for a fertility clinic that understands the full picture, we’re here to help you feel seen, supported, and in control.
Use our Clinic Match tool to find fertility clinics that align with your needs — and take one step closer to the answers (and care) you deserve.
Sources
1. https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics
2. https://www.endometriosis-uk.org/what-endometriosis
3. https://www.endometriosis-uk.org/diagnosis-report
4. https://www.nhs.uk/conditions/endometriosis/
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911462/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066945/
7. https://www.fertstert.org/article/S0015-0282(08)00975-8/fulltext
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC3096669/
9. https://uijir.com/wp-content/uploads/2024/01/8.8.-ENDOMETRIOSIS.pdf
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC2941592/
11. https://flipbooks.leedsth.nhs.uk/LN005669.pdf
12. https://www.leedsth.nhs.uk/patients/resources/deep-infiltrating-endometriosis/
13. https://www.endometriosis-uk.org/pain-relief-endometriosis
14. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/endometriosis/
15. https://www.theendometriosisfoundation.org/diet-and-lifestyle
16. https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01157-8