Adenomyosis vs Endometriosis: How Are They Different
Adenomyosis and endometriosis are often confused with one another, and it's easy to see why. Both conditions can cause pelvic pain, heavy bleeding, challenges with fertility, and disruption to daily life. Yet despite these shared symptoms, they affect the body in very different ways.
Understanding which condition is present is an important step toward finding the right path forward. Each requires a thoughtful, personalised approach to care. If your symptoms have never been fully explained or you feel unsure about what is happening in your body, we are here to support you.
Where each condition grows (and why that matters)
The main difference between adenomyosis and endometriosis is where these tissues grow. Where the tissue grows affects which symptoms you'll experience, how each condition is diagnosed, and how each condition affects your fertility.
Adenomyosis grows inside the uterine muscle
The endometrial cells, which normally line the inside of your uterus, can start growing inside the muscular wall of your uterus. They still respond to every hormonal change in your cycle. They thicken, just as your normal uterine lining does, and then break down in the same way. However, this blood has nowhere to flow. This causes thickening of the uterine wall, which leads to an enlarged uterus.
This problem remains confined to the uterus and does not spread to other parts of the body.
Endometriosis grows outside the uterus
This tissue may invade the ovaries, fallopian tubes, pelvic cavity, and uterine ligaments. It may also invade the bowel or bladder. Like adenomyosis, this tissue reacts to your menstrual cycle. It thickens and breaks down each month and bleeds, but it has no way to exit your body.
This causes inflammation and scarring. It may also cause adhesions that bind your organs together. The more tissue that is involved, the more involved your symptoms and treatment will be.
Research comparing the pathogenesis of both conditions has shown that although they share major molecular events in common, the microenvironments in which each disease process occurs are unique. This is why they have different pathogenesis despite having a similar histological appearance.
How the symptoms compare
There is a level of crossover here, which is one of the reasons these two conditions tend to get mixed up. However, there are general differences in how the symptoms present, and these are helpful to understand.
Heavy bleeding and an enlarged uterus with adenomyosis
The most common symptom experienced by women with adenomyosis is heavy menstrual bleeding. This heavy bleeding is often accompanied by clots. Some women may also experience severe menstrual cramps. A deep ache in the pelvic region is felt during this time. Some women may also experience painful intercourse, especially deep intercourse.
In some cases, a doctor may notice that the uterus is swollen and tender to the touch. This is often seen in women with adenomyosis and is a key feature used to support diagnosis. That said, adenomyosis is sometimes referred to as the "silent disease" because some women may have no symptoms at all. If heavy or painful periods are affecting your daily life, targeted support can help reduce bleeding and pain cycle by cycle.
Chronic pelvic pain and fertility problems with endometriosis
Endometriosis typically involves chronic pain that is not limited to your period. You may feel pain during ovulation, pain during bowel movements, pain during sex, and a low-grade ache that persists in the time between your periods. The pain associated with endometriosis can be debilitating and may increase with time.
Fertility issues are a significant aspect. Endometriosis is a major reason for infertility. Scar tissue and adhesions may cause a blockade in the fallopian tubes and alter pelvic anatomy. It may also cause inflammation that influences ovum quality and implantation capacity. Floralia Wellness provides endometriosis natural medicine support that works alongside your medical treatment to reduce inflammation and pain, and to help rebalance hormones.
Symptoms they share
Adenomyosis and endometriosis share similar symptoms, such as painful periods, heavy menstrual bleeding, and general pelvic pain. Both have the potential to cause anaemia due to excessive menstrual blood loss. Both have a hormonal component, and both can be life-altering if not well supported. This is where your symptom history becomes your most valuable tool.
Can you have both at the same time?
Yes, and this is also common. One in three women with endometriosis also have adenomyosis. Some studies have suggested that this number may be even higher. A systematic review conducted in 2025 that included close to 199 million women found that while the prevalence rate for adenomyosis in the general public is about 1%, and for endometriosis it is about 5%, in women experiencing infertility the prevalence rate is much higher for both conditions.
The presence of both conditions at the same time may exacerbate symptoms and make diagnosis harder, because the symptoms of one may mask or amplify the other. Recent studies have also investigated whether these two conditions share a common underlying cause. While common mutations in KRAS genes may be present, this is not yet conclusive evidence that they are phenotypes of the same disease.
If you have been diagnosed with one condition but your symptoms are not entirely consistent with that diagnosis, or if your symptoms are only partly alleviated by treatment, it is worth considering whether the second condition may also be present.
How each condition is diagnosed
Diagnosis is where these two conditions start to differ significantly, and where a lot of women get stuck.
Ultrasound and MRI scans for adenomyosis
Ultrasound scanning, particularly when done transvaginally in skilled hands, may reveal the characteristic thickening of the uterine wall and alterations in uterine muscle texture. MRI scans provide more information and may be necessary when ultrasound results are inconclusive.
Your past medical history and physical examination are generally sufficient to reach a diagnosis. However, in some instances, adenomyosis is only diagnosed after hysterectomy when tissue samples are examined in a laboratory.
Why the diagnosis of endometriosis often involves laparoscopy
Endometriosis is not easily visible through imaging. An MRI may show larger patches of endometriosis, especially when they are located on the ovaries (endometriomas) or in the bowel area. However, it may not show the smaller patches of endometrial tissue that are often located throughout the pelvic area.
Ultrasound has similar limitations. The gold standard for the diagnosis of endometriosis is laparoscopy. This is a minimally invasive surgical procedure that allows a specialist to visually examine the areas outside the uterus. This is one reason the average time for the diagnosis of endometriosis is so long.
Why misdiagnosis is so common
The two conditions share symptoms with a surprisingly long list of other possible diagnoses. For instance, heavy and painful periods could also suggest the presence of fibroids. Painful sex could also be attributed to relationship factors or vaginismus.
This is especially true when a physician finds one reason and does not continue to look for others. A woman may be told she has fibroids based on ultrasound and not be checked for adenomyosis, which often presents alongside fibroids. Floralia's practitioners also provide a natural fibroid treatment and can help you understand whether other issues may be contributing to your symptoms. Another woman may be told her pain is caused by IBS because her ultrasound appears normal, when in fact endometriosis is causing it and cannot be seen on a routine ultrasound.
If your symptoms do not clear up with the treatment that has been prescribed, or if something still does not make sense, ask for further investigation. Make a point to ask about adenomyosis and endometriosis by name. Women who advocate more clearly for their testing tend to reach a diagnosis more quickly than those who wait for their practitioner to suggest it.
How adenomyosis and endometriosis affect fertility in different ways
While both conditions can harm fertility, they affect it in different ways. This difference is important in guiding the appropriate management for each condition.
Adenomyosis is known to affect what happens after conception. The thickened uterine muscle may affect the implantation of an embryo. The fertilised egg may not be able to implant well in the thickened uterine wall. Evidence also shows that adenomyosis may lead to miscarriages, possibly because of the effects of the thickened uterine muscle on the support of a pregnancy. The key mechanisms of adenomyosis-related infertility, as identified by a literature review, include the destruction of myometrial architecture and uterine peristalsis, as well as abnormal inflammatory responses.
Endometriosis, by contrast, tends to affect the events that occur before conception. Scar tissue and adhesions can physically obstruct or distort the fallopian tubes, which prevents conception between an egg cell and a sperm cell. Inflammation in the pelvic environment can affect egg quality and function. Endometriomas on the ovaries can affect egg reserve. A landmark study of 104 papers by a group of scientists concluded that the presence of endometriosis resulted in a decrease in the number of oocytes and the rates of fertilisation in all cases. Severe cases of the disease also had an impact on all stages of reproduction.
If you are dealing with both conditions, you could be facing issues in several areas of the fertility process. A thorough evaluation before you start fertility treatment helps make sense of what is happening. Understanding the source of the problem, whether it is implantation, tubal function, egg quality, or a combination, helps your fertility specialist know the best course of action for you. A fertility naturopath can support your healthcare team by nourishing healthy eggs and helping to address the inflammation that disrupts your environment for conception.
Treatment options compared
Treatment for both conditions is based on the severity of symptoms, whether you are planning to conceive, and your previous response to treatment.
Pain management using NSAIDs
NSAIDs are usually the first treatment a doctor recommends for mild to moderate period pain in both conditions. NSAIDs work by reducing the amount of prostaglandins that cause cramping. They can help ease pain associated with mild to moderate symptoms, but they do not address the underlying condition.
Hormonal therapies for both conditions
Here, the aim is to prevent the hormonal changes that lead to tissue growth in both conditions. This can be achieved through the combined oral contraceptive pill and progestins. Gonadotropin-releasing hormone agonists can also be used in resistant cases. These help reduce tissue growth, lighten bleeding, and ease pain. However, most hormonal therapies for these conditions prevent conception while they are in use, which is the main disadvantage for longer-term use. If you are not sure about the status of your hormones, hormone testing can help you gain a clearer understanding.
The role of a Mirena IUD in adenomyosis
A levonorgestrel-releasing IUD releases progesterone locally into the uterus, making the uterine lining thinner and reducing heavy bleeding. This can be a long-term option for women who are not trying to conceive, without the systemic hormonal side effects of other medications.
Surgical options for endometriosis
Laparoscopic excision is considered the best method of physically removing endometrial-like tissue growths from the pelvic organs. A surgeon removes endometrial-like tissue, scar tissue, and adhesions. This is considered to help reduce pain and increase fertility, especially if the fallopian tubes or ovaries have endometriosis. Note that the skill of the surgeon is critical, so it is important to find a specialist, not a general surgeon, with experience in excision rather than ablation.
Uterine artery embolisation and endometrial ablation
In uterine artery embolisation, the blood supply to the adenomyosis deposits is cut off. This causes the deposits to shrink and the heavy bleeding to stop. In endometrial ablation, the uterine lining is destroyed to stop the heavy bleeding. Both of these procedures work well to stop the bleeding, but they cannot be used if there is a desire for a future pregnancy.
When a hysterectomy is considered
For adenomyosis, this is the definitive solution in cases where all else has failed, and fertility is no longer a concern. For endometriosis, hysterectomy is not as clear-cut, as the condition exists outside the uterus as well as inside, and symptoms can still be present afterwards. It is a decision taken with a full understanding of the implications of the procedure.
Naturopathic approaches to managing both conditions
Conventional treatment of both conditions focuses on managing symptoms and slowing the progression of the disease. A naturopathic approach complements conventional treatment by focusing on the inflammatory and hormonal environment that allows both conditions to occur.
Anti-inflammatory support through diet and herbal medicine
Chronic inflammation is a major pain and growth factor in both adenomyosis and endometriosis. At Floralia Wellness, our dietary support for women with adenomyosis or endometriosis aims to help you minimise inflammation through dietary choices that include increasing omega-3 fatty acids, reducing processed foods and refined sugars, and identifying any individual food sensitivities that may be contributing to your overall symptoms. A clinical nutritionist can help you design an individualised anti-inflammatory diet plan.
Herbal medicine adds an extra dimension. Anti-inflammatory and hormone-regulating herbs prescribed by your naturopath can help with pain relief and support the regulation of your menstrual cycles, while also supporting the health of your tissues. These are not generic herbs off the shelf. They are carefully prescribed and formulated by your naturopath in response to your individual symptomology and cycle patterns, including any conventional treatment you may be undertaking.
Working with your medical team and your naturopath together
Our practitioners at Floralia communicate directly with your GP and gynaecologist, or endometriosis specialist if you have access to one, to ensure we are working together to provide the best outcome for you. If you are preparing for surgery, there are many things we can do to support your body in healing from that surgery. If you are managing your endometriosis long-term, we can support your hormonal therapies or pain management strategies without interfering with them.
This model of care offers a holistic approach to endometriosis, combining conventional medicine and natural medicine.
What happens after menopause
Both adenomyosis and endometriosis are influenced by oestrogen, and as a result, the symptoms of these conditions often improve significantly after menopause. This is a welcome relief for most women.
However, "improve" does not always mean "disappear." Some women may still experience symptoms after menopause if scar tissue has formed. Hormone replacement therapy may also trigger symptoms in some women, which is something to discuss with your doctor if you are considering it. The menopause and perimenopause practitioners at Floralia can help guide you through this decision-making process with an integrative approach that considers your full medical history.
When to seek specialist help
If you have been experiencing heavy and painful periods that affect your daily life, or chronic pelvic pain that does not respond to simple pain relief, it may be time to seek specialist help rather than continuing to manage on your own. This also applies if you have been experiencing difficulties conceiving.
Ask your GP for a referral to a gynaecologist who has experience with both adenomyosis and endometriosis. If your symptoms have not been adequately explained or if your current treatment is not effective, let your doctor know.
