Key facts
- A fibroid is smooth muscle and fibrous tissue in the uterine wall. Adenomyosis is lining tissue, endometrial glands and stroma, in the uterine muscle1.
- Adenomyosis often causes symptoms similar to fibroids1. The ESUR leiomyoma guideline lists fibroid symptoms such as abnormal uterine bleeding and pelvic pain, and it does not give a separate adenomyosis symptom list2.
- Ultrasound is the first-line test for leiomyomas. MRI is used for mapping and when ultrasound is indeterminate2. Three-dimensional ultrasound with Doppler has shown a sensitivity of 93% for fibroids and 96% for adenomyosis when separating the two, and MRI can also differentiate them1.
- Coexistence of adenomyosis and leiomyomas is not rare and should be reported2.
- de Bruijn and colleagues compared embolization for pure adenomyosis with embolization for adenomyosis plus fibroids. They called the effects on symptom improvement and uterine volume reduction in adenomyosis encouraging3.
- Talk with your doctor before you decide. This information does not replace personal medical advice.
What is different in the tissue
A fibroid is smooth muscle and fibrous tissue in the uterine wall. Adenomyosis is lining tissue, endometrial glands and stroma, in the uterine muscle1. The what are fibroids page describes the same tissue difference.
Why symptoms alone may not separate them
Adenomyosis often causes symptoms similar to fibroids1. The ESUR leiomyoma guideline lists fibroid symptoms such as abnormal uterine bleeding and pelvic pain, and it does not give a separate adenomyosis symptom list2. Because the symptoms can be similar, a symptom list by itself may not tell you which condition is present.
Why this matters: When symptoms are similar, the next step in the conversation is often imaging rather than guessing from symptoms. Bring your imaging report to the visit, and use the fibroid MRI report guide for words that often appear on reports.
Questions to ask
- Which of my symptoms could fit adenomyosis, fibroids, or both?
- Can symptoms alone separate the two in my case, or do we need imaging?
- What should I bring from my report to this visit?
How imaging can separate them
Ultrasound is the first-line test for leiomyomas. MRI is used for complementary mapping and when ultrasound is indeterminate2. Three-dimensional ultrasound with Doppler has shown a sensitivity of 93% for fibroids and 96% for adenomyosis when separating the two. MRI can also differentiate fibroids from adenomyosis1. A consensus statement covers ultrasound features of adenomyosis4.
Questions to ask
- What did my ultrasound show, and what remains unclear?
- If ultrasound is indeterminate, would MRI be used for mapping in my case?
- Which report words should I ask you to explain?
What about UFE for adenomyosis?
de Bruijn and colleagues compared uterine artery embolization (UAE, also called UFE) for pure adenomyosis with embolization for adenomyosis plus fibroids. The review had no fibroid-only group. Symptom improvement occurred in 83.1% (872/1,049) of patients. Symptom reduction was 4.8% greater in the short-term combined group (P = .169) and 11.4% greater in the long-term combined group (P = .003). The authors called the effects on symptom improvement and uterine volume reduction in adenomyosis encouraging3. If embolization is part of the visit, bring questions to ask before UFE.
Questions to ask
- Is adenomyosis alone the main finding, or is a fibroid also present?
- How do you describe UAE outcomes when adenomyosis is present alone, and when fibroids are also present?
- What other options should we compare before I decide?
Both conditions and other questions
Coexistence of adenomyosis and leiomyomas is not rare2. The coexistence of adenomyosis should be reported, as it may require changes in the embolization protocol and might have a negative impact on long term results2. Adenomyosis and endometriosis often cause symptoms similar to fibroids, and MRI can differentiate fibroids from those conditions1. Ask your doctor which conditions your own imaging does and does not address.
Questions to ask
- Does my report mention both fibroids and adenomyosis?
- If only one is mentioned, was the other looked for?
- Should another condition be considered for my symptoms?
Questions to ask before you decide
A fibroid and adenomyosis differ in the tissue involved, and the two can be present together1,2. Talk with your doctor before you decide. Other fibroid guides are collected in the fibroid article library.
Questions to ask your doctor
- Which condition best explains my symptoms, and how sure are we?
- Would MRI change the conversation before we discuss treatment?
- How does the answer change what we compare, including non-surgical fibroid treatment?
Common questions
What is the difference between adenomyosis and fibroids?
A fibroid is smooth muscle and fibrous tissue in the uterine wall. Adenomyosis is lining tissue, endometrial glands and stroma, in the uterine muscle1. Adenomyosis often causes symptoms similar to fibroids1. The ESUR leiomyoma guideline lists fibroid symptoms such as abnormal uterine bleeding and pelvic pain, and it does not give a separate adenomyosis symptom list2. Ultrasound is the first-line test for leiomyomas. MRI is used for mapping and when ultrasound is indeterminate2. Three-dimensional ultrasound with Doppler has shown a sensitivity of 93% for fibroids and 96% for adenomyosis when separating the two, and MRI can also differentiate them1. Talk with your doctor before you decide.
Can adenomyosis be mistaken for fibroids on ultrasound?
How often ultrasound mistakes one condition for the other is not given as one number. A consensus statement covers ultrasound features of adenomyosis4. Three-dimensional ultrasound with Doppler has shown a sensitivity of 93% for fibroids and 96% for adenomyosis when separating the two1. Ultrasound is the first-line test for leiomyomas, and MRI is used for mapping and when ultrasound is indeterminate2. Talk with your doctor before you decide.
Does UFE work for adenomyosis?
de Bruijn and colleagues compared uterine artery embolization for pure adenomyosis with embolization for adenomyosis plus fibroids. The review had no fibroid-only group. Symptom improvement occurred in 83.1% (872/1,049) of patients. Symptom reduction was 4.8% greater in the short-term combined group (P = .169) and 11.4% greater in the long-term combined group (P = .003). The authors called the effects on symptom improvement and uterine volume reduction in adenomyosis encouraging3. Talk with your doctor before you decide.
Can you have fibroids and adenomyosis together?
Coexistence of adenomyosis and leiomyomas is not rare2. The coexistence of adenomyosis should be reported, as it may require changes in the embolization protocol and might have a negative impact on long term results2. Talk with your doctor before you decide.
Is adenomyosis the same as endometriosis?
Adenomyosis and endometriosis often cause symptoms similar to fibroids, and MRI can differentiate fibroids from those conditions1. Talk with your doctor before you decide.
Talk with your doctor before you decide. This information does not replace personal medical advice. Read the medical disclaimer.