Expert / 25 April, 2023 / Dr Raj Arora

The Difference Between Endometriosis and Adenomyosis

Dr. Raj Arora shares the difference between endometriosis and adenomyosis with this in-depth article

Endometriosis affects 1 in 10 women and those assigned female at birth. That’s 1.5 million women in the UK. It is a chronic condition found in women of all social and ethnic groups.

Endometriosis is often misunderstood and mistaken for other conditions, most commonly adenomyosis. The main difference between these two conditions is where the uterine tissue grows. In endometriosis, it grows outside of the uterus onto other organs and in adenomyosis it grows into the uterine muscle. It is also important to consider that these conditions can occur separately or together.

What is endometriosis?

It occurs when tissue that lines the inside of your uterus (Endometrium) grows outside of your womb. This tissue may develop onto the ovaries, fallopian tubes, bowels or bladder. This tissue outside of the womb behaves in the same way as the uterus (Womb lining) and, therefore will react to the menstrual cycle each month and bleed. There is no escape out of the body for this blood, and this, in turn, can lead to pain, inflammation and scarring. It can take an average of 7 years to get a diagnosis.


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What is adenomyosis?

Adenomyosis is when tissue from the lining of the uterus (womb) grows into the uterine wall. This tissue still behaves as it would if it lined the uterus, so it thickens and bleeds with a women’s monthly hormone cycle. Adenomyosis can affect as many as 1 in 10 women of reproductive age. It is more common in women aged 40-50 years who have not gone through menopause and are still having periods.

Adenomyosis versus endometriosis


Adenomyosis and endometriosis have some common symptoms:

• Pelvic pain, worse during a period
• Unusual bleeding patterns – long, irregular or missed periods
• Heavy periods
• Trouble conceiving – infertility

Additional symptoms of adenomyosis include swollen abdomen ( as the uterus becomes enlarged). Endometriosis can lead to scarring and, depending on the organs impacted, can also cause symptoms of pain and bowel dysfunction.


It is not fully understood what causes either condition.

Endometriosis is thought to be caused by “retrograde menstruation,” a theory that suggests that during a person’s period, some of the menstrual flow travels backward through the fallopian tubes allowing the tissue to move elsewhere in the body.

Adenomyosis, on the other hand, is thought to occur due to a disruption in the boundary between the uterine (womb) muscle and the deepest layer of the uterine (womb)lining.

Risk factors


  • Having a mother, sister or daughter with endometriosis
  • Started periods before age 11
  • Heavy periods
  • Shorter monthly cycles
  • Low BMI
  • Disorders of the reproductive tract


  • Tamoxifen treatment post-cancer
  • Middle age
  • Childbirth
  • Prior uterine surgery
  • Smoking


For both, it is important to be able to visualise the tissue, and therefore laparoscopy surgery such as a hysteroscopy can confirm the diagnosis. In adenomyosis – imaging such as MRI or ultrasound may help aid diagnosis.


*Both may be managed with pain medications
*Hormone medications, such as the pill, can help both diseases from progressing. In endometriosis, it can help prevent the formation of scar tissue.
*sure treatment -= surgery. This may be a hysterectomy to remove the uterus, but if endometriosis, it may be surgery to remove affected tissue and remove scar tissue also.

Common complications of adenomyosis and endometriosis:

  • Anaemia from heavy periods (chronic)
  • Infertility from scarring or implantation issues

It is also important to recognise that the two conditions can co-exist. If you are worried about symptoms, see your GP for early diagnosis and treatment.

Article by Dr. Raj Arora, one of the UK’s leading medical educators, a highly respected NHS GP, and founder of The Facebible.

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