If you’re concerned about adenomyosis and seeking a diagnosis or treatment, you may wonder if Magnetic Resonance Imaging (MRI) can help. Adenomyosis can be a challenging condition, often causing painful symptoms that can affect your everyday life. Knowing that options are available for diagnosis and treatment can bring some relief. An MRI scan is a valuable tool for diagnosing adenomyosis. It provides clear and detailed images of the uterine tissues, which helps your clinician identify the condition and rule out any other possible causes. This can help you move towards the best treatment plan to manage your symptoms and improve your quality of life.
What is MRI Adenomyosis?
Adenomyosis (uterine adenomyosis) is a condition where functional endometrial tissue (the lining of the uterine cavity) grows deep into the muscle layer of the womb (uterus), also known as ectopic endometrial glands. This abnormal placement of tissue can lead to changes in the shape and size of the endometrial cavity. Adenomyosis can affect anyone with periods but is more common in people between the ages of 30 and 50. Symptoms of adenomyosis can be painful and life-changing. They include:
- heavy, painful periods
- pain during sex
- abnormal bleeding
- chronic pelvic pain
- bloating or a heavy, full feeling in your tummy
- trouble conceiving
- an enlarged womb
Knowing that the condition can be managed and improved with the right treatment is important. An MRI is particularly effective for diagnosing adenomyosis because it provides detailed images of the uterine tissues. MRI helps your clinician spot the key signs of the condition, such as thickening of the muscle layer of the womb (myometrium) or areas where endometrial tissue has grown into this muscle layer. MRI is often used when other imaging methods, like ultrasound, don't provide enough detail for a diagnosis.
Types of Adenomyosis
Adenomyosis is divided into four main types. Each type is defined based on where and how far the endometrial tissue has grown into the uterine muscle.
Diffuse Adenomyosis
Diffuse adenomyosis is the most common type, where the tissue has spread throughout the muscle, causing the muscle wall to thicken evenly over a large area. It can cause heavy periods, generalized pelvic pain, and an enlarged womb. It affects around two-thirds of people with the condition.
Focal Adenomyosis
Focal adenomyosis affects up to a third of people with the condition and causes isolated uterine masses of endometrial tissue within the myometrium, causing localized areas of thickness. It causes symptoms similar to those seen in people with fibroids, such as pelvic pain and heavy periods.
Adenomyoma
Adenomyoma is a specific type of focal adenomyosis, where the endometrial tissue creates a distinct mass within the uterine wall, similar to a fibroid. However, unlike fibroids (which are made of smooth muscle tissue), adenomyomas contain endometrial glands. It can cause pelvic pain and heavy bleeding.
Cystic Adenomyosis
Cystic adenomyosis is a rare form of the condition. It causes fluid-filled cysts within the inner myometrium, which are thought to form when endometrial tissue bleeds during the menstrual cycle. It can cause severe pelvic pain and other symptoms similar to ovarian cysts and may be more common in younger women.
Will Adenomyosis Be Shown on an MRI?
Yes, an MRI is one of the best ways to spot adenomyosis and get a diagnosis of the condition. It can also help your doctor identify which type of adenomyosis you have, where it's located, and to what extent the myometrium is affected. An MRI for adenomyosis can show where the uterine wall has thickened. One of the main signs is that the inner layer of the uterus (called the uterine junctional zone) gets thicker. Usually, this layer is thin (about 5 mm), but it can be 12 mm or more with adenomyosis. Affected areas will look darker, thicker, and more blurred than usual. If there are cysts present, these will appear as bright spots surrounded by darker areas of thickened muscle tissue. MRI can also show areas of trapped blood inside the uterine muscle where the tissue has grown into it. These will show up as bright spots on the MRI results. T2-weighted images, which are a part of your MRI scan, are especially useful for seeing the tissues in detail. These images highlight differences in water content between tissues, which helps identify abnormal areas.
Diagnosis of Adenomyosis
There are several steps your doctor will take to diagnose adenomyosis. Here’s a guide to what will usually happen and in what order.
Medical History Review
Your clinician will ask about your medical history and symptoms, including how long you’ve been experiencing pain or heavy periods. They’ll also ask you about your menstrual cycle and any irregularities, your history of uterine procedures or surgeries, and any family history of adenomyosis or related conditions.
Physical Pelvic Examination
Following your medical history, your clinician will feel around the uterus (palpate) for signs of uterine enlargement or tenderness, which can be indicators of adenomyosis.
Ultrasound
Your doctor may recommend an ultrasound to take a closer look at the womb and uterine wall. This is likely to be a transvaginal ultrasound, which offers a more detailed view of your internal organs than a regular ultrasound scan.
Magnetic Resonance Imaging (MRI)
MRI is the gold standard for diagnosing adenomyosis because it can provide a much more detailed view of the womb and the uterine wall. It can also identify complex cases where other conditions, such as endometriosis or fibroids, may be present. Contrast-enhanced MRI can be particularly useful in assessing adenomyosis and its effects on the endometrial cavity and surrounding tissues. Contrast agents, usually gadolinium-based, are injected into your bloodstream before your scan. These agents help to highlight differences between normal and abnormal tissues, making it easier to identify areas affected by adenomyosis.
Endometrial Biopsy (To Rule Out Other Conditions)
An endometrial biopsy involves having a small sample of tissue taken from the lining of the womb. It’s carried out in a similar way to a smear test. Your clinician may recommend an endometrial biopsy in order to rule out other conditions, such as endometrial hyperplasia or cancer, especially if you’re experiencing abnormal bleeding.
Blood Tests (To Check for Anemia and Other Conditions)
Your clinician will also recommend blood tests to check for conditions caused by heavy bleeding, such as anemia. They may also check your hormone levels and rule out other underlying conditions that can affect periods, such as thyroid or blood clotting disorders.
Diagnosis Difficulties
Diagnosing adenomyosis can be tricky, even with advanced imaging techniques like MRI. This is because its symptoms often overlap with other conditions like endometriosis and fibroids. There are no standard guidelines for diagnosing adenomyosis either. This can lead to varying interpretations of imaging results by different doctors, which can sometimes result in misdiagnosis. Hormones play their part too. The uterine junctional zone is a specific area in the womb that separates the endometrium from the myometrium, and it’s a key area that doctors examine for signs of adenomyosis. During your period, it can appear thicker, which can indicate adenomyosis even if you don't have the condition. In around a third of postmenopausal women, the junctional zone may not even be visible, and it can also change in appearance if you’re on hormonal contraceptives. Despite these complications, a combination of medical history, physical examination, and imaging techniques means that you’re more likely to get a correct diagnosis, especially with an MRI scan.
Differential Diagnosis
There are several conditions with similar symptoms to adenomyosis that your clinician will consider and may rule out using examinations, scans, and blood tests. These include:
- Fibroids: Uterine fibroids are well-defined, solid masses in the uterine muscle, while adenomyosis commonly causes general ill-defined thickening without distinct boundaries.
- Endometriosis or endometrial polyps: In endometriosis, endometrial tissue grows outside the womb, unlike adenomyosis, which is inside the uterine wall. This can form polyps that can vary in size and are usually benign.
- Endometrial hyperplasia: This involves thickening of the endometrium, whereas adenomyosis affects the myometrium.
- Uterine cancer (endometrial cancer): Cancer forms a mass or tumor inside the uterine lining, while adenomyosis thickens the muscle layer without forming distinct tumors.
- Pelvic Inflammatory Disease (PID): An infection of the reproductive organs, PID can cause pelvic pain but shows different signs of inflammation with imaging.
- Transient uterine contractions: These are normal contractions of the uterus that can be seen on an MRI, and could mimic the bulging that signals adenomyosis.
- Asherman's Syndrome: Scar tissue in the womb causes irregularities in menstrual bleeding, but it’s identified by adhesions rather than the muscle thickening seen in adenomyosis.
Why an MRI Scan is a Good Option
An MRI scan can provide a clear and detailed view of your womb and the surrounding tissues. It’s safe, non-invasive, and doesn’t involve radiation, making it a good option if you need several scans. It’s particularly helpful in allowing your clinician to spot signs of adenomyosis and rule out other conditions with similar symptoms, such as fibroids or endometriosis. It can also help show how severe your condition is, which will allow your clinician to recommend the best treatment plan for you.
How an MRI Scan Detects Adenomyosis
MRI scans for adenomyosis use powerful magnetic fields and radio waves to create detailed 3D images of the muscles and soft tissues in your uterus.
The procedure begins by aligning water molecules in your body with the magnets; then, radio waves disrupt this alignment. As the molecules realign, they send out signals that the MRI machine detects. A computer processes these signals to generate highly detailed images.
This process continues slice by slice until a detailed image of your womb and the surrounding tissue is formed, revealing any areas where adenomyosis or other abnormalities may be present.
Find an MRI Scan for Adenomyosis
Living with adenomyosis can be painful and affect your quality of life, but an MRI can help you get the right treatment - whether that’s medication, hormonal therapy or surgery. If you’re not sure whether an MRI is the right scan for you, our expert clinician consultations will help you figure out the next steps so you can find the best options for managing your symptoms and improving your well-being.
Treatment Options
Living with adenomyosis can be challenging, but there are several treatment options available to help ease your pain and improve your daily life.
Anti-Inflammatory Medications
Non-steroidal anti-inflammatory drugs (NSAIDs) can help to ease the pain you experience with adenomyosis. However, NSAIDs can’t treat the underlying condition or slow its progression.
Hormonal Therapy
Your doctor may recommend hormonal treatments to manage your symptoms, including an intrauterine system (IUS), also known as the coil, the progestogen-only pill, the combined pill or the contraceptive patch. They work by suppressing the endometrial lining and reducing menstrual flow, which can ease pain and reduce heavy bleeding. Hormonal therapy can be particularly helpful if you want to have children in the future, as it can help manage your symptoms without the need for invasive procedures.
GnRH Agonists
Gonadotropin-releasing hormone (GnRH) agonists are another option for managing adenomyosis. They cause a temporary menopause-like state by reducing your oestrogen levels, which can shrink lesions and ease your symptoms. However, GnRH agonists have side effects, including bone density loss and menopausal symptoms, so you will need other medication to mitigate their effects.
Endometrial Ablation
Endometrial ablation is a minimally invasive procedure that uses heat to destroy the endometrial lining and reduce your menstrual bleeding. It’s shown promise in women with adenomyosis, particularly those who don’t want to have children (2023). However, its effectiveness can vary based on the extent of adenomyosis, and it can have complications, such as infection, bleeding, or damage to other internal organs from the heat.
Uterine Artery Embolisation (UAE)
UAE is a procedure that blocks blood flow to the uterine arteries and shrinks adenomyotic tissue. It can reduce heavy menstrual bleeding and pelvic pain, making it a good option if you want to avoid a hysterectomy. Although it's possible to get pregnant after having UAE, the overall effects of the procedure on fertility and pregnancy are uncertain, so be sure to discuss the risks and benefits with your doctor.
Hysterectomy
Hysterectomy is the definitive treatment for adenomyosis, particularly if you’ve completed your family or you have severe symptoms that aren’t responding to other treatments. However, it’s a major operation with a long recovery time, and it’s irreversible, so future pregnancies will not be possible.
Pain Management
As well as painkiller medication, such as paracetamol and ibuprofen, there are helpful strategies to use when dealing with the pain of adenomyosis. These can include:
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Applying a heat pad or hot water bottle wrapped in a tea towel to your tummy and pelvic area to ease discomfort.
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Using a TENS Machine that sends mild electrical impulses that can help reduce pain.
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Trying alternative treatments, such as physical therapy, acupuncture, and lifestyle changes that focus on reducing stress and improving your overall well-being.
Sources:
Adenomyosis. (2023). https://my.clevelandclinic.org/health/diseases/14167-adenomyosis
Adenomyosis. (2023). https://www.nhs.uk/conditions/adenomyosis/
Adenomyosis. (2024). https://radiopaedia.org/articles/adenomyosis?lang=gb
Adenomyosis. (N.D.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/adenomyosis
Agostinho, L., et al. (2017). MRI for adenomyosis: a pictorial review. https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0576-z
Endometrial ablation. (2024). https://www.southtees.nhs.uk/resources/endometrial-ablation/
Mishra, P. et al. (2023). Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.26159
Rees, C. O., et al. (2021). Objective measures of adenomyosis on MRI and their diagnostic accuracy—a systematic review & meta-analysis. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14139
Vannuccini S, Petraglia F. (2019). Recent advances in understanding and managing adenomyosis. https://pmc.ncbi.nlm.nih.gov/articles/PMC6419978/
