Pelvic pain is a common problem among women. The difficulty with diagnosing it is that many types of diseases and health conditions can cause pelvic pain. 

“Adenomyosis is a fairly common cause of pelvic pain that typically occurs in women in their 40s and 50s,” says Candace Giles, DO, a Nebraska Medicine obstetrician-gynecologist. “But current research indicates that the condition may also be more common in younger women.” 

Adenomyosis happens when the lining of the uterus grows into the muscular wall of the uterus. During menstruation, this tissue thickens, breaks down and bleeds. This can result in heavy bleeding and painful periods. 

If left untreated, heavy bleeding may lead to anemia, which can cause other health problems. In younger women, adenomyosis can cause problems during pregnancy, including miscarriage or preterm birth. 

Symptoms of adenomyosis include:

• Heavy or long-lasting menstrual bleeding.
• Severe cramping.
• Pelvic pain that doesn’t go away.
• Bloating.
• Enlarged and tender uterus.
• Painful sex.

While the exact cause of adenomyosis is unknown, there are several theories about possible causes that include: 

• Trauma between the lining and muscle of the uterus.
• Lesions that form in the lining of the uterus during menstruation.
• Inflammation of the uterus after childbirth.
• Embryonic tissue left in the uterus during fetal development.

“Because there are so many conditions that can cause pelvic pain as well as irregular bleeding, diagnosing the cause of your pelvic pain is often a process of elimination,” says Dr.  Giles. “My evaluation starts with a detailed history and physical and a pelvic exam to determine if the uterus is enlarged or tender. This will be followed by an ultrasound and an MRI, if needed.”

These tests can help detect signs of adenomyosis or other conditions, such as polyps, fibroids or endometriosis. 

“Unfortunately, the only way to confirm adenomyosis with total certainty is by examining the uterus after a hysterectomy,” notes Dr. Giles.

Treatment

If the medical evaluation and testing leads to a suspected diagnosis of adenomyosis, a treatment plan is developed based on symptoms, age and fertility goals. Treatment focuses on symptom management or a hysterectomy.

“Having the uterus removed with a hysterectomy is the only way to completely cure this condition,” says Dr. Giles. “For older women, symptoms often end after menopause. If you are nearing menopause or hope to become pregnant, we will start with a treatment plan that entails managing the symptoms.”

Treatment may include:

• Nonsteroidal anti-inflammatory medications, to help reduce pain.
• Hormonal medications, taken by mouth or with an intrauterine device, to control estrogen and reduce heavy bleeding.
• Hysterectomy, if pain and heavy bleeding continue and pregnancy is not a goal.

“Most women will get substantial relief with symptom management and can still get pregnant if desired,” says Dr. Giles.

Risk factors for adenomyosis include:

• Prior uterine surgery.
• Previous pregnancy.
• The start of menstrual cycles at age 10 or younger.
• Menstrual cycles with fewer than 25 days between periods.

“If you are experiencing pelvic pain that isn’t going away, it is important to seek medical advice to diagnose the cause and get proper treatment,” says Dr. Giles. “This is especially important if you are of child-bearing age, as some conditions can cause permanent damage and directly impact fertility by causing inflammation, scarring or blockages.”

Other common causes of pelvic pain

Pelvic pain can also be caused by:  

• Menstrual cramps.
• Endometriosis.
• Uterine fibroids or polyps.
• Ovarian cysts.
• Urinary tract infections.
• Pelvic inflammatory disease.
• Irritable bowel syndrome.
• Pelvic floor dysfunction.
• Pregnancy issues. 

“You should not let pelvic pain affect your quality of life,” says Dr. Giles. “In most cases, we can diagnose and treat your condition and get you back to a normal lifestyle again.”