What are the signs of adenomyosis?

Adenomyosis more commonly diffusely thickens the junctional zone, but can be present in a more focal form (adenomyoma) which can simulate a fibroid, particularly if one only relies on pelvic ultrasound for imaging (vs. MRI). It can cause generalized enlargement of the uterus which (like fibroids) can be detected on physical exam. The thickening/enlargement of the junctional zone preferentially involves the portion of the uterus which lies just posterior to the uterine cavity. Like fibroids, the main symptoms of patients with adenomyosis are pelvic pain and increased menstrual bleeding. However, typically with adenomyosis patients, the pain is significantly worse than the bleeding, whereas with symptomatic fibroid patients, it is usually the opposite (i.e. heavy bleeding worse than the pain). In addition, patients suffering with fibroids commonly complain of increased urinary frequency which is not typically seen with adenomyosis. Finally, adenomyosis patients commonly have routinely painful intercourse (dyspareunia) or avoid intercourse due to the pain, whereas fibroid patients rarely have this symptom unless there is a fibroid near the cervix.