Adenomyosis on Ultrasound: What Does the Report Mean?

Adenomyosis on ultrasound means the scan showed changes in the muscle wall of the womb (uterus) that suggest tissue like the womb lining is growing into it. It is not cancer. It can cause heavy or painful periods, but some people have no symptoms, so the finding needs to be matched with how you actually feel.

Adenomyosis is common. Healthdirect says it is thought to affect about 1 in 5 people who have periods, usually between the ages of 30 and 50. The NHS notes it is more likely in people who have given birth and in people with endometriosis, and the cause is not clear.

A report may say adenomyosis is 'suggested', 'possible' or 'features of' it, rather than confirmed. This guide explains the wording and helps you prepare questions. It cannot tell you whether you have adenomyosis or which treatment is right for you.

The NHS advises asking for an urgent GP appointment or contacting an urgent advice service if pelvic or period pain is severe or worse than usual and painkillers have not helped. Seek emergency care through local services if you have sudden severe pain, or bleeding so heavy that you feel faint, dizzy or very unwell.

Book a prompt, non-urgent appointment if:

• your periods have become more painful, heavier or irregular
• heavy periods are affecting work, study or daily life
• you bleed between periods or after sex
• you have pain during or after sex
• you have felt bloated most days for about three weeks
• you feel tired or breathless, which can happen with low iron from heavy bleeding

A pelvic ultrasound is the usual first scan, and Healthdirect notes that an internal (transvaginal) scan may give clearer pictures of the womb. Reports may describe a thickened or uneven muscle wall, one wall thicker than the other, a rounded or enlarged womb, or small fluid-filled spaces in the muscle. Cleveland Clinic notes the womb can become noticeably enlarged.

A 2024 review in the Journal of Clinical Medicine describes direct signs, such as small cysts in the muscle, and indirect signs, such as a globular womb or uneven wall thickening. It notes that indirect signs alone leave the diagnosis uncertain. Adenomyosis can be spread through the wall (diffuse) or limited to one area (focal); a well-defined focal area is sometimes called an adenomyoma. Some reports simply say the womb is 'bulky', which our separate guide explains.

Ultrasound and MRI are both used. Ultrasound is widely available and well tolerated, so it is usually done first. The NHS and Healthdirect say MRI is used in some cases. The 2024 review reports that the two tests have broadly similar ability to detect adenomyosis, with MRI tending to give fewer false positives. Which one is used depends on availability, the experience of the person doing the scan and the clinical question.

Neither test is perfect. Changes can be subtle, and fibroids in the same womb can make the picture harder to read. The NHS notes that diagnosis can take a long time because symptoms overlap with other conditions. If your symptoms are significant and the scan was unclear, ask whether a repeat scan by a specialist sonographer or an MRI would change the plan. Our guide on severe period pain with a normal ultrasound covers what to do when the scan looks normal.

Yes. The 2024 review states that adenomyosis often coexists with endometriosis and fibroids. Healthdirect notes that people can have both adenomyosis and endometriosis and that their features can overlap. The NHS says having endometriosis raises the chance of adenomyosis.

The conditions are different. Adenomyosis is within the muscle of the womb. Endometriosis is tissue like the womb lining growing outside the womb, for example on the ovaries, where it can form cysts called endometriomas. Fibroids are separate growths of the womb muscle. Because they cause similar symptoms, a report that mentions one does not rule out the others.

If you have no symptoms, a finding of possible adenomyosis may need no treatment. When symptoms are present, the NHS and Healthdirect say treatment depends on the symptoms, your life stage and whether you want to become pregnant. A blood test may be offered to check for low iron if bleeding has been heavy.

Options described by these sources include pain relief, medicines to reduce heavy bleeding, and hormonal treatments such as a hormonal intrauterine device or certain contraceptive pills. If these do not help, procedures such as uterine artery embolisation or surgery may be discussed. The NHS notes hysterectomy is the only cure but ends the ability to become pregnant. Cleveland Clinic notes symptoms usually settle after menopause.

Before your appointment, it can help to note for two or three cycles how many days you bleed, whether you pass clots or flood through protection, how strong the pain is and what it stops you doing. This gives your clinician more to work with than the scan report alone.

Bring the full report and a simple record of your periods, pain and bleeding over a few cycles. These questions can help you agree a plan.

• Does the report say adenomyosis is likely, possible or confirmed, and which features were seen?
• Is it diffuse, focal, or an adenomyoma, and does that change my options?
• Were fibroids, endometriosis or anything else also seen or not assessed?
• Would an MRI or a repeat specialist scan change what we do next?
• Should my iron levels be checked because of heavy bleeding?
• How would each treatment affect my pain, bleeding and plans for pregnancy?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with similar scan wording and symptoms described their path, including whether MRI was used, can help you shape questions for your own appointment.

Other people's cases cannot confirm or rule out adenomyosis for you, and their treatment may not suit you. Use them to prepare, and rely on your own clinician for diagnosis and decisions.