Written by Rhiannon Davis. Reviewed by Jenny Wordsworth. 

For Endometriosis Awareness Month, we surveyed over 100 women and people with endometriosis about their experiences of trying to conceive. One theme came through loud and clear: “I wish more people knew about adenomyosis.”

Despite being relatively common, adenomyosis is still seriously under-discussed, especially when it comes to fertility. There’s a lack of research, a lack of answers, and too often, a lack of support. So if you’re a researcher looking for your next study subject, talk to people with adenomyosis. There is still much that needs to be investigated.

In the meantime, if you're trying to conceive and either have adenomyosis or suspect you might, this guide is for you. It covers what we do know, from symptoms and diagnosis to its link with endometriosis and how it can impact fertility, along with practical steps you can take to support your reproductive health naturally.

What is Adenomyosis?

Adenomyosis happens when tissue that’s usually found lining the uterus (the endometrium) starts growing into the muscular wall of the uterus (the myometrium). This can cause the uterus to enlarge and can lead to symptoms like:

• Painful, heavy periods

• Pelvic discomfort or a feeling of heaviness

• Pain during sex

• Severe cramps or primary dysmenorrhea (80% of those with adenomyosis report experiencing this)

• Bloating;

• and sometimes, no symptoms at all.

It’s more commonly diagnosed in people over 40, but younger people, especially those with other gynaecological conditions, can be affected too. And frustratingly, because symptoms overlap with other conditions like fibroids or endometriosis, it can be hard to get a clear diagnosis.

Adenomyosis and Endometriosis: What’s the Connection?

Adenomyosis and endometriosis often go hand in hand, showing similar histological patterns (basically, the way cells and tissues organise themselves and appear under examination). Around 30-50% of people with adenomyosis also have endometriosis, and the two conditions share similar symptoms: pain, fatigue, and potential fertility issues.

But they’re not the same. Endometriosis involves endometrial-like tissue growing outside the uterus, while adenomyosis involves tissue growing into the uterine muscle. This can make adenomyosis trickier to detect, as it doesn’t show up on standard imaging as clearly and is often misdiagnosed or missed altogether.

Both conditions are linked with chronic inflammation and hormonal disruption, which can make it harder to conceive and carry a pregnancy to term.

How Does Adenomyosis Affect Fertility?

Research is still evolving, but studies suggest adenomyosis may:

• Lower chances of conception through intercourse

• Reduce IVF success rates

• Increase the risk of miscarriage and preterm birth

The exact mechanisms aren't fully understood, but theories include disrupted uterine contractions, which can affect implantation, inflammation, and changes to the endometrial environment.

That said, not everyone with adenomyosis will struggle to conceive,  and it’s absolutely possible to get pregnant naturally. It may just take a bit longer or require additional support.

How Is Adenomyosis Diagnosed?

For your doctor to be able to detect signs of adenomyosis,, they’ll usually take the following steps:

• Pelvic exam – your doctor may feel an enlarged or tender uterus

• Ultrasound – can help spot thickening of the uterine wall

• MRI – considered the gold standard for diagnosis, offering clearer images

Previously, the only definitive diagnosis used to be through tissue samples taken after a hysterectomy, which isn’t helpful if you’re trying to conceive, because a hysterectomy involves removing the uterus, making pregnancy no longer possible. But imaging has come a long way, and more gynaecologists are now recognising the signs earlier and treating accordingly.

Risk Factors to Know About

Certain factors can increase the risk of developing adenomyosis, or make fertility issues more likely:

• Age (typically 35+)

• Previous pregnancies

• C-section or other uterine surgeries

• Endometriosis

• High oestrogen levels (which can be linked to higher body weight or hormone use)

• Smoking

Can Lifestyle Changes Help?

While there’s no cure for adenomyosis (yet), there’s growing evidence that specific lifestyle changes may help support fertility and overall reproductive health.

• Nutrition - A diet rich in whole foods (think leafy greens, wholegrains, fruit, lean protein, and anti-inflammatory fats like olive oil) may help reduce inflammation and support hormone balance.

• Movement - Gentle to moderate exercise like walking, swimming or yoga can improve circulation to the pelvic area, regulate hormones, and reduce stress. Avoid over-exercising, as that can negatively impact hormone levels.

• Stress - We know, easier said than done. But chronic stress can affect hormone function and ovulation, so finding ways to support your mental health really matters. That could mean therapy, journaling, spending time in nature, or just taking things off your plate where you can.

• Reduce exposure to toxins - Try to limit exposure to environmental toxins like pesticides, endocrine-disrupting chemicals (EDCs), and smoking, all of which can impact fertility. Filter your water, choose fragrance-free or eco products where possible, and avoid smoking or vaping.

• Supplements - Consider a good quality preconception supplement that includes folate, vitamin D, and other key nutrients for egg health and hormonal balance. Some people also choose to take CoQ10, particularly if they're over 35, as there’s evidence it may support egg quality.

Key Takeaways on Adenomyosis

Adenomyosis can make trying to conceive feel harder and lonelier. It’s an area that’s massively underserved by research, and too many people are left feeling dismissed or confused.

But knowledge is power. Understanding how the condition works and making small changes to support your body and mind can help you take back some control.