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Adenomyosis and Endometriosis: What’s the Difference, and Where Might Acupuncture Fit?

If you’ve ever wondered whether adenomyosis and endometriosis are basically the same thing, you’re not alone. The names are often mentioned together, some of the symptoms overlap, and both can become part of the conversation when periods are painful, heavy or simply no longer feel manageable.

But they are different conditions.

A simple way to picture the difference is to imagine the uterus as a room with a thick wall.

With adenomyosis, tissue similar to the lining of the uterus is found within that wall. With endometriosis, similar tissue is found outside the uterus altogether, often elsewhere in the pelvis, for example around the ovaries or near the bowel or bladder.

That sounds quite neat on paper. In real life, though, things can be much less tidy.

Why They Can Feel So Similar

Someone with adenomyosis may notice that their periods have become heavier, longer or much more painful. There can be a deep aching sensation, pressure in the pelvis or a feeling of heaviness and bloating.

Someone with endometriosis may also have painful periods, but the pain can show up in other ways too; during sex, when opening the bowels, when passing urine, or at other points in the menstrual cycle. Fatigue is also commonly reported, and fertility difficulties can sometimes be part of the picture.

None of these symptoms belongs exclusively to one condition. Heavy bleeding, for example, can also occur with fibroids or other causes of abnormal uterine bleeding, while pelvic pain and period pain may have a number of possible explanations.

It is also possible to have adenomyosis and endometriosis at the same time.

So symptoms can give useful clues, but they cannot tell us the cause on their own.

Who Tends to Develop Adenomyosis?

Adenomyosis is most often identified in women in their 40s and 50s. It also appears to be more common in women who have previously been pregnant and in those who also have endometriosis.

But these are patterns, not rules. Adenomyosis can occur in younger women too, so age alone should not be used to dismiss symptoms that need investigating.

Why Diagnosis Can Sometimes Feel Frustrating

For many people, one of the hardest parts is that getting an answer isn’t always immediate. This is particularly true with endometriosis.

Recent data from Endometriosis UK puts the average time from first seeing a GP about symptoms to receiving an endometriosis diagnosis in the UK at 9 years and 4 months. That does not mean everyone will wait that long, but it does underline why ongoing symptoms deserve to be taken seriously.

A doctor will usually start by asking about your periods, the timing and pattern of pain, bleeding, bowel or bladder symptoms, pain during sex, and how much all of this is affecting everyday life. A simple symptom diary can be surprisingly useful because it may reveal patterns that are difficult to remember clearly in an appointment.

For adenomyosis, a transvaginal ultrasound is often the first imaging test used, with MRI sometimes helping if more detail is needed.

Ultrasound is also an important first step when endometriosis is suspected. It can identify ovarian endometriomas and some forms of deep endometriosis.

But there is an important point here: a normal ultrasound does not always rule out endometriosis.

Small or superficial areas may not be visible on routine imaging. A normal scan can sometimes feel as though it has closed the conversation, when in fact persistent symptoms may still need further consideration.

In some situations, MRI or laparoscopy may be considered. If periods are very heavy, blood tests may also be useful to check for iron-deficiency anaemia.

What Treatment Can Look Like

Treatment depends very much on the symptoms, scan findings, age, previous treatment, other health conditions and whether pregnancy is currently desired.

Treating Adenomyosis

For adenomyosis, managing pain and heavy bleeding is often a priority. The levonorgestrel-releasing intrauterine system, or LNG-IUS often known as Mirena or the hormonal coil, may be offered because it can make periods lighter and less painful. Other options can include hormonal contraception, anti-inflammatory pain relief or tranexamic acid to reduce heavy menstrual bleeding.

If symptoms remain severe despite other approaches, surgery may sometimes be discussed. A hysterectomy removes the uterus and therefore the adenomyosis within it, but it is major and irreversible surgery and is generally considered when other treatments have not helped enough and future pregnancy is not desired.

Treating Endometriosis

With endometriosis, care may also include pain relief and hormonal medication, with surgery considered in some circumstances to treat areas of endometriosis, ovarian endometriomas or adhesions. You can read more in our detailed guide on acupuncture for the treatment of endometriosis.

If pregnancy is a priority, treatment choices need additional thought because some hormonal options prevent conception while they are being used.

What About Fertility?

Endometriosis can be associated with difficulty conceiving, although many people with the condition become pregnant naturally.

Adenomyosis is also being studied in relation to fertility and assisted conception, but the evidence is less clear and cannot predict what will happen for an individual.

If fertility is a concern, it is important to look at the wider picture including age, ovulation, ovarian reserve where appropriate, fallopian tube health, sperm health and how long pregnancy has been attempted.

A diagnosis may be part of the story without being the whole story.

So Where Might Acupuncture Fit?

For someone living with adenomyosis or endometriosis, the impact is not always limited to the diagnosis itself. Recurring pain, difficult periods, disturbed sleep and the ongoing strain of managing symptoms can all affect everyday life. If this sounds familiar, our article on the healing touch of acupuncture for chronic period pain explores this in more depth.

This is where acupuncture may have a supportive role alongside medical care.

The research is stronger for endometriosis-related pain than it is for adenomyosis. A 2024 systematic review and meta-analysis by Chen and colleagues reported improvements in endometriosis-related period pain, pelvic pain and quality of life in people receiving acupuncture.

The studies varied in size, quality and the way acupuncture was delivered, so the findings still need some caution. However, they do suggest that acupuncture is an area of genuine interest for managing endometriosis-related symptoms, particularly pain. You may also find our piece on living with endometriosis: how acupuncture can help useful.

How Might Acupuncture Influence Pain?

There are several possible explanations for how acupuncture may influence the experience of pain.

Research has explored its effects on pain-processing pathways and naturally occurring pain-modulating chemicals such as endorphins, as well as possible effects on prostaglandins and other inflammatory signalling involved in pain.

These mechanisms are still being investigated. They may help explain how acupuncture could influence pain perception, but they should not be taken as evidence that acupuncture removes endometriosis lesions or adenomyosis itself.

For adenomyosis specifically, the evidence is much more limited. Some studies have explored acupuncture, but there is not yet enough high-quality research to draw reliable conclusions about adenomyosis-specific symptoms.

There is also a broader body of research into acupuncture for period pain and some forms of chronic pain. Although that evidence is not specific to adenomyosis or endometriosis, it helps explain why some patients choose to include acupuncture as one part of a wider approach to managing pain and wellbeing, alongside their women’s health care.

In practice, I see acupuncture as something that can sit alongside GP, gynaecology, fertility or pain-management care. The focus is on supporting the person living with the symptoms, with treatment shaped around what they are experiencing and what else is happening in their health and life.

When Is It Worth Asking for Medical Advice?

If your periods are becoming much more painful or heavy, pelvic pain is affecting everyday life, you are experiencing pain during sex, bowel or bladder symptoms, bleeding between periods or after sex, or you are struggling to conceive, it is worth speaking to your GP.

Heavy bleeding can also lead to iron-deficiency anaemia, so unusual fatigue, dizziness or breathlessness should not be ignored.

New pelvic symptoms or bleeding after menopause should always be medically assessed. Sudden severe pelvic pain, extremely heavy bleeding, fainting, or severe pain when you may be pregnant need urgent medical attention.

A Few Common Questions

Can adenomyosis and endometriosis occur together?

Yes. They are separate conditions, but they can occur together. Having one does not automatically mean you have the other.

Does heavy bleeding mean I have adenomyosis?

Not necessarily. Heavy bleeding is commonly associated with adenomyosis, but it can also happen with fibroids, endometriosis and other gynaecological conditions.

Can acupuncture be used alongside medication or fertility treatment?

Often, yes, provided it is clinically appropriate. Your acupuncturist should know about your medication, procedures, bleeding, possible pregnancy and fertility treatment schedule.

Acupuncture should not be used as a reason to stop medication, alter a fertility protocol or delay medical investigation.

Finding the Right Next Step

Pelvic pain and difficult periods can be exhausting, especially when you are still waiting for answers.

You do not need a confirmed diagnosis before asking for help. And if you do receive one, you do not have to make every treatment decision at once.

The important thing is that your symptoms are taken seriously and that you have the information and support you need to make sense of your options.

If acupuncture is something you are considering, it may be one supportive part of that wider care. At The Acupuncturists, treatment is always shaped around the individual, not just the diagnosis.

Medical disclaimer

This article is for general information only and does not provide a diagnosis or replace individual medical advice. Pelvic pain, heavy bleeding and changes to your periods can have many causes. Please speak to your GP or an appropriate healthcare professional if symptoms are persistent, severe, changing or affecting your daily life.

Sources and further reading