If you or someone close to you is dealing with adenomyosis, you are likely to know it can be a challenging condition, especially where pregnancy is concerned. Adenomyosis occurs when the tissue that lines the uterus grows into the muscular wall of the uterus. This change can make the uterus larger than usual, often causing heavy or painful periods and a feeling of pressure in the lower abdomen.
Although adenomyosis and endometriosis are sometimes talked about together, they’re actually quite different. While endometriosis involves similar tissue growing outside the uterus, adenomyosis affects only the uterine muscle. This distinction is important as it can impact how symptoms show up and the approach to managing them. Treating adenomyosis pre conception is usually recommended. At The Rylon Clinic, we offer excellent private adenomyosis treatment in London. Where surgical intervention is required, minimally invasive procedures like keyhole adenomyomectomy can preserve fertility.
Whether you’re exploring what adenomyosis might mean for pregnancy or supporting a loved one through it, understanding these basics can offer a sense of clarity and reassurance on the journey ahead. For those considering hysterectomy post pregnancy, you may wish to read our article Does Hysterectomy Cause Menopause?
Can I have a baby if I have adenomyosis?
Many people with adenomyosis achieve successful pregnancies, but research suggests that managing the condition before conception can greatly improve pregnancy outcomes. When left untreated, adenomyosis may increase the risk of pregnancy complications due to the structural and inflammatory changes it causes in the uterus.
Adenomyosis involves the growth of endometrial tissue into the muscular wall of the uterus (the myometrium). This growth disrupts the normal structure of the uterine muscle, leading to an inflamed, thicker uterine wall. This inflammation and disruption can interfere with key processes that support a healthy pregnancy, such as implantation, placental development, and the growth environment for the foetus [1]. The increased uterine muscle mass and inflammation may also contribute to a heightened risk of preterm labour and restricted foetal growth, as the uterus is less able to expand smoothly [2].
Untreated adenomyosis is associated with complications such as:
Premature birth: The increased thickness and rigidity of the uterus may cause it to contract prematurely, increasing the likelihood of early delivery.
Restricted foetal growth: Inflammation and irregular blood flow in the uterus can restrict the delivery of oxygen and nutrients to the developing foetus.
Higher risk of miscarriage: The inflammatory environment in the uterus can interfere with embryo implantation and early pregnancy stability, leading to higher miscarriage rates [3].
Mild adenomyosis and natural pregnancy
For those with mild adenomyosis, these structural changes are often less severe, meaning that the uterus retains more of its flexibility and functional structure. This often results in a higher likelihood of natural conception and fewer complications.
However, even mild adenomyosis can lead to increased inflammation, which can disrupt implantation and early pregnancy. Seeking treatment before pregnancy can improve the uterine environment by addressing this inflammation, enhancing the chances of a healthy pregnancy [4].
Benefits of seeking preconception treatment for adenomyosis
When adenomyosis is treated before attempting to conceive, the uterus can be restored to a more stable state, reducing the risk of complications during pregnancy. Treatments, including hormonal therapies or minimally invasive procedures, can help decrease inflammation, reduce the size of adenomyotic lesions, and promote better blood flow to the uterine wall. This preconception care helps create an environment that supports healthy implantation and foetal growth.
Research indicates that individuals with adenomyosis who seek treatment before pregnancy experience fewer complications, including a reduced risk of preeclampsia, placental issues, and premature labour, compared to those who do not receive treatment [5]. Preconception treatment thus plays a vital role in lowering the risks associated with adenomyosis and promoting a healthier, more stable pregnancy journey.
Symptoms of adenomyosis during pregnancy
For some women, pregnancy may be the first time they discover they have adenomyosis. In cases where symptoms were mild or manageable before pregnancy, the condition may not have been diagnosed, leading to unexpected symptoms during this new stage. Adenomyosis can cause the uterus to enlarge and become more tender, which can sometimes lead to heightened discomfort during pregnancy.
The pregnancy experience for women with adenomyosis varies widely. Some may experience only mild symptoms, while others may notice an increase in certain symptoms due to the hormonal changes and increased blood flow during pregnancy. Common symptoms include:
Pelvic pain and pressure: Many women report a feeling of heaviness or pressure in the pelvic area, which can be more noticeable as the uterus expands.
Abdominal cramping: Cramping is often mild but can be more intense for some, particularly as the uterus stretches to accommodate the growing baby.
Spotting or bleeding: Light spotting can occur, though it’s important to discuss any bleeding with a healthcare provider.
Discomfort in the lower back: This is another common experience, as adenomyosis can cause a sense of strain that adds to the typical back discomfort during pregnancy.
Despite these symptoms, many women with adenomyosis go on to have healthy pregnancies. However, it’s helpful to be aware of these potential signs and discuss any discomfort with a healthcare provider.
Managing adenomyosis-related pregnancy pain
Managing pain related to adenomyosis during pregnancy can be challenging, as many typical pain relief options are limited for pregnant women. That said, there are several safe, supportive methods that can make a difference in comfort:
Gentle exercise: Activities like prenatal yoga, walking, and stretching can help relieve pelvic pressure and lower back pain. Gentle movement also promotes blood flow, which can reduce inflammation and ease discomfort.
Heat therapy: Applying a warm (not hot) compress to the lower abdomen or back can help soothe cramping and pelvic pain. A warm bath may also provide relief, although care should be taken to avoid excessive heat.
Pelvic support belts: These belts can help alleviate the feeling of heaviness by supporting the weight of the uterus, reducing strain on the lower abdomen and back.
Regular check-ins with a healthcare provider: For women with adenomyosis, regular appointments provide an opportunity to discuss any new or worsening symptoms and ensure both mother and baby are healthy. Providers can also offer guidance on managing specific symptoms as they arise, helping to create a plan tailored to the individual’s comfort and wellbeing.
By being mindful of symptoms and using gentle, supportive pain management strategies, many women find relief from adenomyosis-related discomfort during pregnancy. A proactive approach can help make the journey smoother, even when symptoms are unexpected or more intense than anticipated.
Risk factors to be aware of
If you’re planning to conceive and have adenomyosis, addressing the condition before pregnancy can reduce risks significantly. Preconception treatment, including hormonal therapies or minimally invasive procedures, can lower inflammation, improve uterine flexibility, and enhance blood flow to the uterus. By stabilising the uterine environment, treatment helps support a healthy implantation and pregnancy journey, minimising the potential for complications like preterm birth or growth restrictions.
For those who are already pregnant, staying informed and vigilant about symptoms can provide reassurance. Regular communication with your healthcare provider ensures that any developing risk factors are identified early, giving you and your baby the best chance of a healthy pregnancy.
How to achieve a healthy pregnancy
For women with adenomyosis, careful planning and, if possible, preconception treatment can create a more comfortable and stable foundation for pregnancy. Pre-treatment can reduce many of the condition’s effects, offering a clearer path to a healthy pregnancy. For those who discover their adenomyosis after conceiving, there are also effective symptom management strategies.
1. Managing uterine health for comfort
With preconception treatment:
When adenomyosis is treated before pregnancy, the uterine wall stabilises, inflammation decreases, and blood flow improves, helping reduce symptoms like cramping and pelvic pressure. Research highlights that hormonal treatments and minimally invasive surgeries can reduce uterine inflammation, often making pregnancy less symptomatic and more comfortable [6].
If untreated before pregnancy:
For those already pregnant, gentle measures can still provide symptom relief. Low-impact exercises such as swimming and prenatal yoga support circulation and ease pressure, while pelvic support belts help manage discomfort by providing structural support. Regular rest and stretching also promote uterine relaxation and reduce cramping.
2. Reducing the risk of pregnancy complications
With preconception treatment:
Pre-pregnancy treatment of adenomyosis, such as hormonal regulation or surgery, has been shown to reduce risks associated with the condition, including premature labour and foetal growth restrictions. Studies indicate that women who treat adenomyosis before pregnancy experience fewer complications, as these treatments optimise the uterine environment for implantation and foetal development [7].
If untreated before pregnancy:
For those pregnant without pre-treatment, frequent prenatal monitoring is essential. Regular check-ups help identify potential issues early, allowing for prompt intervention if necessary. An anti-inflammatory diet, rich in leafy greens, omega-3 fatty acids, and antioxidant-rich foods, may also help support uterine health during pregnancy by reducing inflammation.
3. Hormonal stability and symptom management
With preconception treatment:
Pre-pregnancy hormone treatments can stabilise the hormonal environment, reducing adenomyosis symptoms and creating a stronger foundation for pregnancy. Hormonal regulation can mitigate the effects of adenomyosis on uterine tissue, contributing to a less disruptive and more enjoyable pregnancy journey [8].
If untreated before pregnancy:
Mindfulness techniques, such as meditation and yoga, can help manage stress hormones, promoting hormonal stability during pregnancy. Complementary therapies, like acupuncture, may also support symptom relief by promoting blood flow and managing pain, although these should be practised with certified professionals during pregnancy.
Does adenomyosis go away after pregnancy?
For many women, pregnancy can bring temporary and may be long-term relief from adenomyosis symptoms due to hormonal changes. However, it’s common for symptoms to return, often as menstrual cycles resume. Some women experience a reduction in symptoms such as heavy bleeding and cramping postpartum, while others may find that symptoms return or even intensify.
Breastfeeding can extend the symptom relief by suppressing ovulation and menstruation, but once breastfeeding is reduced and menstrual cycles return, symptoms like pelvic pain and heavy bleeding may reappear.
If adenomyosis is left untreated, it may increase the risk of complications in subsequent pregnancies, such as preterm labour, restricted foetal growth, and even miscarriage due to the ongoing inflammation and structural changes in the uterine tissue [9].
Treatment options after pregnancy
For those experiencing a resurgence of symptoms after pregnancy, treatment options are available and can be tailored to align with future family planning goals. Treatments generally begin once the body has fully recovered from childbirth, typically six to twelve weeks after delivery, though some hormonal therapies can be started earlier if symptoms are severe and after consulting with a healthcare provider. Here are some effective options:
Hormonal therapies: Options like progestin therapy, hormonal contraceptives, or GnRH agonists can regulate hormone levels and reduce inflammation. These therapies can be suitable for women who may plan future pregnancies, as they manage symptoms without permanent uterine changes [10].
Minimally invasive procedures: For women not planning additional pregnancies, options like uterine artery embolisation (UAE) or endometrial ablation can provide significant relief. UAE reduces blood flow to adenomyotic tissue, which can shrink the inflamed areas, while endometrial ablation targets the uterine lining to control bleeding. These treatments are generally recommended several months postpartum, once the uterus has returned to its normal size [11].
Hysterectomy: For those with severe, unmanageable symptoms who do not plan to conceive again, a hysterectomy (removal of the uterus) is a definitive treatment option. While more invasive, it provides complete relief from adenomyosis symptoms and can greatly improve quality of life for women struggling with chronic pain and heavy bleeding [12].
By working closely with a specialist, women can determine a personalised treatment plan that supports both symptom management and any future reproductive goals. This proactive approach helps to minimise the impact of adenomyosis on daily life and future pregnancies, creating a healthier foundation for the future.
When to seek professional help
For women with adenomyosis who are planning to conceive or expand their family, seeking specialist care early is one of the best ways to support a smoother pregnancy experience. Consulting a specialist before conception allows for personalised treatment plans that can significantly reduce symptoms, minimise risks, and help prepare the body for a healthy pregnancy. Treatments such as hormonal therapy or minimally invasive procedures are tailored to optimise uterine health, creating a more stable environment for conception and reducing the likelihood of complications.
For those who have experienced adenomyosis-related symptoms in a prior pregnancy- such as heavy bleeding, cramping, or early contractions, preconception care can make a substantial difference. Addressing adenomyosis before a subsequent pregnancy can help reduce the chance of similar challenges, allowing for a more comfortable and less stressful journey.
How the Rylon Clinic can support your pregnancy journey
The Rylon Clinic is committed to helping women manage adenomyosis before conception or in preparation for a subsequent pregnancy. The Rylon Clinic offers comprehensive preconception care to support women in achieving optimal uterine health. With advanced treatments and a personalised approach, The Rylon Clinic aims to help women reduce adenomyosis symptoms before pregnancy, increasing the likelihood of a healthy and positive experience. By preparing the body for pregnancy, The Rylon Clinic empowers women to approach conception with confidence and clarity, knowing they are supported every step of the way.
The importance of quality care if already pregnant
If you are already pregnant and managing adenomyosis, seeking high-quality prenatal care is essential to ensure both your health and your baby’s wellbeing. Though the Rylon Clinic focuses on preconception support, many healthcare providers offer excellent prenatal care tailored to managing adenomyosis symptoms during pregnancy.
Regular check-ups allow healthcare providers to monitor foetal growth, address emerging symptoms, and respond to any complications early. High-quality prenatal care can provide options for symptom relief, such as gentle exercise plans, safe dietary adjustments, and effective symptom management techniques, helping to make your pregnancy as comfortable as possible.
Even if adenomyosis was not treated before conception, working closely with a healthcare provider ensures that you have the support needed to manage symptoms effectively and to feel reassured throughout your pregnancy journey.
Understanding adenomyomectomy
An adenomyomectomy is a surgical procedure designed to remove adenomyotic tissue from the uterus while preserving the organ itself. It is a fertility-preserving option for women with severe adenomyosis, particularly those who have not responded well to conservative treatments like hormonal therapies and are experiencing debilitating symptoms, such as chronic pelvic pain, heavy menstrual bleeding, and cramping.
Who does adenomyomectomy help?
This procedure is most beneficial for women who:
Experience severe symptoms that significantly impact their quality of life
Have not found relief from other treatments, such as hormonal contraceptives or anti-inflammatory medication
Wish to maintain fertility and avoid a hysterectomy, which would involve removing the uterus completely
Adenomyomectomy is generally recommended for women who plan to conceive in the future, as it aims to alleviate symptoms and restore uterine function without removing the uterus.
What happens during the procedure?
An adenomyomectomy is performed by a skilled gynaecologic surgeon, often with expertise in minimally invasive or fertility-preserving surgery. The procedure typically involves the following steps:
Anaesthesia: The surgery is conducted under general anaesthesia, ensuring the patient is fully asleep and comfortable throughout the procedure.
Incisions: Depending on the case, the surgeon may use laparoscopic (keyhole) techniques or an open abdominal approach to access the uterus. Laparoscopic/Robotic techniques involve small incisions, which are less invasive and generally lead to a quicker recovery. However, an open approach may be necessary for more extensive cases.
Removal of adenomyotic tissue: The surgeon carefully identifies and excises the adenomyotic tissue embedded within the uterine wall. This process can be complex because the adenomyotic tissue is often deeply integrated into the muscle layer of the uterus (the myometrium). The goal is to remove as much adenomyotic tissue as possible without compromising the structural integrity of the uterus.
Reconstructing the uterine wall: After removing the adenomyotic tissue, the surgeon repairs and reconstructs the uterine muscle to support healing and future pregnancies. This step is crucial to ensure that the uterus retains its shape, strength, and function post-surgery.
Closing incisions: The incisions are closed using sutures, and the patient is monitored closely as they wake up from anaesthetic.
The surgery typically takes a few hours, and patients are advised to stay in the hospital for a day or two following the procedure to monitor for any immediate post-surgical complications.
How does adenomyomectomy help?
By removing the problematic adenomyotic tissue, an adenomyomectomy addresses the root cause of symptoms associated with adenomyosis. It can provide significant relief from chronic pain and heavy menstrual bleeding, allowing the uterus to function more normally and creating a healthier environment for future pregnancies. This procedure can improve quality of life and support reproductive goals by preserving the uterus and restoring its function.
Effectiveness and considerations
While adenomyomectomy is not a guaranteed cure- since some adenomyotic tissue may regrow, the procedure can provide substantial and long-lasting symptom relief for many women. It also offers a viable alternative to a hysterectomy, allowing women to maintain fertility and potentially conceive in the future. However, due to the invasive nature of the procedure, it is generally recommended only after other treatments have been explored.
Adenomyomectomy requires specialised skills in reproductive surgery, and recovery may involve a waiting period of 6 to 12 months before attempting conception to allow the uterus to heal fully. Consulting with an experienced gynaecologist can help determine if adenomyomectomy is the most suitable option based on individual symptoms, reproductive goals, and overall health.
NHS vs. private care for adenomyosis
Support options available on the NHS
The NHS provides a range of services for women with adenomyosis, including diagnostic tests, hormonal therapies, and, in some cases, surgical options to help manage symptoms. However, waiting times for specialist referrals and treatment can vary widely depending on location, which can affect women hoping to conceive sooner rather than later. This can be particularly concerning for women over 35, when fertility starts to decline more noticeable, or for those who wish to maintain a smaller age gap between children.
With NHS care, initial consultations and diagnostic imaging may require waiting periods, particularly for non-urgent cases. Once in the system, patients have access to excellent clinical expertise, but the wait for treatment can be longer than ideal, which may affect timelines for conception. While the NHS provides quality care, women who feel time-sensitive about conception may find these wait times challenging.
Advantages of private treatment for adenomyosis and pregnancy
Private care offers several advantages for women with adenomyosis who wish to conceive sooner, especially for those over 35 or those hoping for a smaller age gap between siblings. In private care, the process typically begins much more quickly, with shorter wait times for specialist consultations, diagnostic imaging, and treatment. Access to immediate, tailored care can help women manage adenomyosis more effectively, reducing symptoms and optimising uterine health to support a quicker path to conception.
Private treatment also often includes access to a broader range of therapies, such as advanced hormonal treatments or minimally invasive surgeries like keyhole adenomyomectomy, designed to alleviate adenomyosis symptoms with minimal recovery time. This approach can help to stabilise the uterine environment faster, reducing inflammation and enhancing fertility sooner. For women facing age-related fertility concerns, timely treatment may play a key role in preserving their reproductive health and providing the best chance for a healthy pregnancy.
In addition, private clinics generally offer a more personalised approach, with dedicated time for consultations and customised treatment plans to meet each individual’s goals. By choosing private care, women have the flexibility to work closely with a specialist to develop a plan that prioritises both symptom management and conception goals, giving them greater control over their reproductive health journey.
Conclusion
For women with adenomyosis, understanding treatment options and planning ahead can significantly improve the pregnancy experience. Early management of symptoms can support a healthier, more comfortable journey, especially for those aiming to conceive sooner or facing age-related fertility concerns. Accessing specialist care, whether through the NHS or private services, allows for a personalised approach that aligns with individual goals and timelines.
The Rylon Clinic offers advanced preconception support, focusing on creating optimal conditions for pregnancy. By providing timely, tailored treatment, we aim to help women with adenomyosis approach conception with greater confidence and clarity.
References
Naftalin, J., et al. (2016). "The effect of adenomyosis on natural conception." Human Reproduction Update, 22(4), 364-376.
Takeuchi, H., et al. (2017). "Adenomyosis and pregnancy complications." American Journal of Obstetrics and Gynecology, 216(1), 99-104.
Andres, M. P., et al. (2018). "Effects of adenomyosis on pregnancy outcomes." Reproductive Sciences, 25(4), 451-457.
Kishi, Y., et al. (2014). "Adenomyosis and reproduction: Insights into clinical impacts and treatment efficacy." Reproductive Medicine and Biology, 13(2), 73-78.
Benagiano, G., & Brosens, I. (2012). "The management of adenomyosis: towards a new clinical approach." Reproductive Biomedicine Online, 24(1), 57-63.
Kishi, Y., et al. (2014). "Adenomyosis and reproduction: Insights into clinical impacts and treatment efficacy." Reproductive Medicine and Biology, 13(2), 73-78.
Andres, M. P., et al. (2018). "Effects of adenomyosis on pregnancy outcomes." Reproductive Sciences, 25(4), 451-457.
Naftalin, J., et al. (2016). "The effect of adenomyosis on natural conception." Human Reproduction Update, 22(4), 364-376.
Benagiano, G., & Brosens, I. (2012). "The management of adenomyosis: towards a new clinical approach." Reproductive Biomedicine Online, 24(1), 57-63.
Kishi, Y., et al. (2014). "Adenomyosis and reproduction: Insights into clinical impacts and treatment efficacy." Reproductive Medicine and Biology, 13(2), 73-78.
Andres, M. P., et al. (2018). "Effects of adenomyosis on pregnancy outcomes." Reproductive Sciences, 25(4), 451-457.
Osada, H. (2011). "Uterine adenomyosis and adenomyomectomy: A novel surgical procedure for diffuse adenomyosis." Reproductive Medicine and Biology, 10(3), 151-157.
Author: Mr Osama Naji
Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.
Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.
He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.
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