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Endometriosis & Adenomyosis

Reviewed 13 September 2026

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They can cause similar symptoms, but they are not the same condition.

How are they found?

Symptoms, examination, ultrasound and sometimes MRI help assessment. External uterine appearance alone cannot diagnose adenomyosis. Normal imaging does not exclude all endometriosis.

Two-panel composite image. Panel A: a black-and-white pelvic MRI scan with a white arrow pointing to a small bright rounded area at the upper edge of the uterus. Panel B: a laparoscopic view of pink pelvic tissue with a black circle drawn around a small raised area and a yellow rounded structure beside it.

Why Does the Difference Matter?

Because the condition causing your symptoms can change the treatment you need.

How is adenomyosis treated?

Treatment depends on symptoms, age and reproductive goals. Medicines can help pain and bleeding; fertility treatment may be appropriate. Selected uterus-preserving surgery requires expert counselling about benefits, complications and risks to a future pregnancy. No single treatment suits everyone.

What about hysterectomy?

Hysterectomy treats uterine adenomyosis; you cannot carry a pregnancy afterward. Endometriosis elsewhere or other causes of pain may remain.

Laparoscopic view of pink-red pelvic tissue with a large pale rounded structure at the centre labelled U, three white arrows pointing to its right-hand surface, an asterisk below it, and the letter R over lower tissue; yellow fatty tissue at the lower left.
Four-panel composite image. Panels A and B: black-and-white pelvic MRI scans, each with a white arrow pointing to a small bright rounded area in the uterine wall. Panel C: a laparoscopic view of a smooth pink rounded structure with a dashed black oval drawn on its surface. Panel D: a laparoscopic view with two metal instruments holding a pale tissue fragment against dark red tissue.

Evidence & review

Endometriosis & Adenomyosis
Version 1.3 · Reviewed 13 September 2026

Definitions and diagnosis

Endometriosis is endometrium-like tissue outside the uterine endometrium and myometrium. Adenomyosis involves endometrial glands and stroma within the myometrium, the muscular uterine wall. They can coexist. Ultrasound and MRI can support diagnosis; external laparoscopic appearance alone does not establish adenomyosis.

Coexistence is an association

Marcellin and colleagues studied 255 symptomatic patients undergoing surgery for deep endometriosis. The association with focal outer-myometrial adenomyosis is a finding in a selected surgical population, not proof that endometriosis causes adenomyosis or that all patients have both.

Fertility evidence has limits

A 2024 IVF/ICSI meta-analysis associates adenomyosis with lower pregnancy and live-birth rates and higher miscarriage rates. The evidence is largely observational and concerns assisted reproduction; it is not an individual prediction or direct estimate for all natural conceptions. Newer reviews describe heterogeneity and uncertain treatment effects.

Treatment and hysterectomy

Treatment depends on symptoms and reproductive goals. Medicines can help pain and bleeding. Selected uterus-preserving surgery needs specialist counselling, including effects on future pregnancy. Hysterectomy definitively treats adenomyosis in the removed uterus and prevents carrying a pregnancy. It does not remove endometriosis elsewhere or guarantee that every cause of pelvic pain will resolve.

Medical information

Seek urgent or emergency assessment for severe or rapidly worsening symptoms.

Version 1.3 · Reviewed 13 September 2026. Proposed next review: September 2027, or sooner if relevant guidance changes.

Full references

Numbers correspond to the sources cited in this revised guide. Access notes distinguish relevant full-text inspection from abstract-only checks. No source is presented as an endorsement of GEM.

This material is for educational purposes only and does not constitute medical advice or create a clinician-patient relationship with GEM.

© 2026 Global Endometriosis Movement. All rights reserved.

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