Adenomyosis: the symptoms, when to see a doctor
Periods that leak through, nights getting up to change, tiredness that won’t go away? Adenomyosis is less well known than endometriosis, but it deserves to be talked about.
Written by Paul, a nurse, founder of EndoQueen. This guide informs; it doesn’t replace an appointment with a health professional.
What is adenomyosis?
The inside of the womb is lined with a layer of tissue, the endometrium. In adenomyosis, this tissue grows into the muscle of the womb. Each cycle, it responds to hormones: the muscle can thicken, and periods can become heavier and more painful.
It can be diffuse (spread through the muscle) or focal (grouped in one place). These words sometimes appear in scan reports.
Adenomyosis and endometriosis: cousins, not twins
Endometriosis is outside the womb. Adenomyosis is in its wall. The ESHRE guideline (2022) considers them two different conditions.
But they often go together, especially with deep endometriosis (Chapron, 2017). If you’ve been told about one, you can ask whether the other has been looked for. See our guide to endometriosis symptoms.
Adenomyosis symptoms: what you feel, what the doctor writes down
According to the AAFP (2022), heavy periods affect 40 to 60% of people with adenomyosis, and about one in three has no symptoms at all.
- “I leak through”: heavy menstrual bleeding.
- “My periods are really painful, worse than before”: secondary dysmenorrhoea.
- “My lower belly hurts even outside my period”: chronic pelvic pain.
- “It hurts deep inside during sex”: deep dyspareunia.
- “I have light bleeding between periods”: spotting.
- “My belly feels bloated and heavy”: pelvic heaviness.
- “I’m exhausted, breathless, pale”: possible iron deficiency.
None of these signs can tell you on its own what you have. Your doctor decides.
Heavy periods: how to describe them to your doctor
“I have heavy periods” is vague. Concrete facts speak straight away. Over one or two cycles, note:
- your period products, and how many a day;
- how often: do you change a full pad or tampon in less than 2 hours? Do you use two at once?
- nights: do you get up to change?
- clots: larger than about 2.5 cm (1 inch)?
- how long: more than 7 days?
- your life: do you avoid going out or sleeping elsewhere because of the bleeding?
Track the pain separately: heavy bleeding and pain don’t always go together.
Tiredness and iron deficiency
Losing a lot of blood, cycle after cycle, can drain your iron stores: great tiredness, breathlessness, dizziness, a racing heart. It isn’t “in your head”.
A blood test lets the doctor check. It’s best not to start iron on your own without talking about it: your doctor decides.
When to see a doctor about adenomyosis
It’s worth booking an appointment if, over several cycles:
- you change your pad or tampon in less than 2 hours, use two at once, or get up at night;
- you pass clots larger than about 2.5 cm (1 inch);
- your periods last more than 7 days;
- you bleed between periods or after sex;
- you feel very tired or breathless, or you get dizzy;
- your pain gets worse or doesn’t ease with your usual painkillers;
- you’re hoping to have a baby, or you’ve had miscarriages (see endometriosis, adenomyosis and fertility).
Emergency: call your local emergency number if you soak through a large pad or tampon every hour for more than 2 hours, if you feel unwell (feeling faint, dizziness, a very fast heartbeat, breathlessness at rest), if you have sudden and unusual pain, a fever with belly pain, or if you could be pregnant and are bleeding or in pain.
If you are having dark thoughts or feel in distress, contact a crisis line in your country or your local emergency number. You don’t have to cope alone.
The usual tests
A pelvic ultrasound scan is the first test. An MRI may be offered if the scan isn’t clear, or before a treatment or fertility treatment. A blood test looks for iron deficiency.
It’s the doctor who interprets the tests, not an app.
Frequently asked questions
Is adenomyosis a form of endometriosis?
No. For ESHRE, they are two separate conditions. But they often go together.
How do I know if my periods are too heavy?
A few pointers are reasons to see a doctor: changing your pad or tampon in less than 2 hours, getting up at night to change, passing clots larger than about 2.5 cm, or periods lasting more than 7 days. Note them and show them to your doctor, who decides.
Can an app tell me whether I have adenomyosis?
No. It shows up on an ultrasound scan or MRI, interpreted by a doctor. An app only helps you note what you’re going through.
If it helps, EndoQueen is on iPhone and Android. A quick journal for pain and bleeding, lined up with your cycles, and a one-page summary for your doctor. It does not diagnose, and your journal stays on your phone. The app is currently in French; the English version arrives in November 2026. Discover the app
Read next
Sources
- AAFP, Adenomyosis: Diagnosis and Management (2022)
- ESHRE, Guideline: endometriosis (2022)
- Chapron C. et al., Human Reproduction (2017), adenomyosis and endometriosis on MRI
- Endometriosis Research Foundation, Adenomyosis (in French)
- CDC, Heavy Menstrual Bleeding
- NICE, Heavy menstrual bleeding: assessment and management (NG88)
Last reviewed: 29 October 2026.