Adenomyosis vs Endometriosis: Differences, Symptoms, and Impact on Fertility

Experiencing painful periods or heavy bleeding is often a sign that you may need medical intervention. These symptoms are common with conditions called adenomyosis and endometriosis. They may affect your fertility and make it harder for you to get pregnant.

What is Endometriosis?

The uterine lining is composed of tissues, but it may also grow outside the uterus in certain cases. This tissue can appear on your ovaries, fallopian tubes, or other parts of your pelvic area. This condition is called endometriosis.

This tissue reacts to your menstrual cycle by thickening, breaking down, and bleeding each month. Since it grows outside the uterus, the blood has no way to leave your body. This causes pain, inflammation, and scarring.

Common symptoms include:

Painful periods
Pain during intercourse
Heavy bleeding
Infertility
Fatigue

Endometriosis can make it harder to get pregnant by blocking the fallopian tubes, affecting egg quality, or causing a hormonal imbalance.

What is Adenomyosis?

Adenomyosis is a condition in which the tissues of your uterine lining grow into the muscular wall of the uterus. This can make your uterus larger and thicker than normal.

Unlike endometriosis, the tissue stays within the uterus but invades the muscle layer. This leads to cramping, heavy bleeding, and discomfort.

Common symptoms include:

Heavy or long periods
Pain during periods
Pelvic pressure or bloating
Pain during intercourse

Adenomyosis is often seen in women in their 30s and 40s, but it can affect younger women too. It may be harder to detect, especially in the early stages.

Key Differences Between the Two

While both conditions involve endometrial-like tissue, they differ in terms of their location and the ways they affect the body.

Aspect	Endometriosis	Adenomyosis
Location	Outside the uterus	Inside the muscle wall of the uterus
Symptoms	Pain, infertility, fatigue	Heavy bleeding, pressure, and cramping
Diagnosis	Often needs laparoscopy	Detected via ultrasound or MRI
Age Group	20s to 40s	30s and above
Impact on Fertility	Direct and often significant	Less direct, but still a concern

Your doctor can decide the best way to manage your symptoms and support your fertility goals after identifying the correct condition.

How Endometriosis Affects Fertility

Endometriosis can interfere with your fertility in several ways:

Scar tissue may block the fallopian tubes, preventing fertilisation.
Inflammation may harm eggs and sperm.
Hormonal imbalances may affect ovulation.
The uterus may not be a good environment for embryo implantation.

The severity of your condition decides whether you can conceive or face challenges. In mild cases, you may still conceive naturally. Treatments like laparoscopy, fertility medication, or IVF may be needed in moderate or severe cases.

How Adenomyosis Affects Fertility

Adenomyosis can also impact fertility, and usually in more indirect ways:

The thickened uterus may interfere with embryo implantation.
Inflammation may affect uterine function.
Abnormal contractions may make it harder for the embryo to attach.

It is also common to have adenomyosis and endometriosis at the same time, which can increase fertility challenges.

Treatment may include hormone therapy, lifestyle changes, or assisted reproductive techniques like IVF if conception is difficult.

Can You Have Both?

You can have both adenomyosis and endometriosis. The symptoms may be more intense, and the impact on fertility can be greater when both are present.

In such cases, your doctor may recommend more detailed testing and a treatment plan that addresses both conditions.

Getting Diagnosed

Endometriosis is usually diagnosed through a laparoscopy. It is a small surgical procedure that allows your doctor to examine the inside of your abdomen and pelvis.

Adenomyosis, on the other hand, is diagnosed through imaging tests like:

MRI scans
Transvaginal ultrasound
In some cases, diagnosis is only confirmed after a hysterectomy, but newer imaging technology has made early diagnosis more common.

It is important to share all your symptoms with your doctor so they can recommend the right tests.

What Can You Do If You're Trying to Conceive?

Here are a few steps you can take if you suspect or have been diagnosed with endometriosis or adenomyosis and are trying to conceive:

Consult a fertility specialist. They can help create a plan that fits your condition and your timeline.
Track your cycles to better understand ovulation and fertile windows.
Consider lifestyle changes, such as managing stress, eating a nutritious diet, and maintaining a healthy weight within normal limits.
Explore treatment options early, especially if you have been trying to conceive for more than 6 to 12 months without success.

Early diagnosis and a personalised plan can make a big difference in your chances of becoming pregnant.

Both adenomyosis and endometriosis can affect your fertility, but they are not the same. Endometriosis usually has a more direct effect on your ability to conceive. Adenomyosis can also create indirect challenges.

Fortunately, many women with these conditions become pregnant after proper diagnosis and the right treatment plan. Talk to your doctor, stay informed, and take one step at a time to support your reproductive health.