Introduction to Endometriosis and Adenomyosis and how exercise can help

Written by Jasmine K

What is Adenomyosis?

Adenomyosis is a condition that affects the uterus only. It occurs when the lining of the uterus (endometrial tissue), which normally sheds during a period, grows into the muscular wall of the uterus. This causes the uterus to enlarge and can lead to various symptoms. Adenomyosis most commonly affects women in their 40s and 50s and is different from endometriosis in its cause, location, and effects.

What is endometriosis?

Endometriosis occurs when similar tissue grows outside the uterus, most often in the pelvic area, such as between the uterus and bowel. It can also involve organs like the ovaries, bowel, pelvic sidewall, and bladder. While both conditions involve similar tissue, they differ in where the tissue is located, the symptoms experienced, and the age group affected.

Endometriosis is more common in younger women, typically in their 20s and early 30s. The updated American Society for Reproductive Medicine (r-ASRM) classification system is used to objectively grade the severity of the condition, ranging from minimal (stage I) to mild (stage II), moderate (stage III), and severe (stage IV).

Symptoms/diagnosis

Adenomyosis most commonly causes very heavy menstrual bleeding.

The uterus may also become enlarged and tender, leading to pelvic pain and discomfort during intercourse. This condition can make it harder to become pregnant and is linked to a higher risk of miscarriage.

Endometriosis mainly causes pain due to inflammation, scar tissue, and organs sticking together. It is more strongly associated with infertility than adenomyosis. While adenomyosis tends to worsen bleeding with age, endometriosis can cause severe, sometimes disabling pelvic pain. Both conditions can have a major impact on quality of life. Some women with either condition experience no symptoms, and the diagnosis may only be discovered through imaging or during surgery, such as a caesarean section. Diagnosis of adenomyosis and endometriosis has improved with advances in ultrasound and MRI. Adenomyosis can often be identified on imaging or suspected based on symptoms and an enlarged uterus, though it may only be confirmed after hysterectomy.

Endometriosis is harder to detect, especially when mild. Specialist ultrasound can identify ovarian cysts, ligament nodules, and scarring that limits organ movement, while MRI can help assess adhesions. The most definitive diagnosis is laparoscopy, which allows direct visualisation and treatment of the disease. Deep infiltrating endometriosis, particularly involving the bowel, remains the most challenging to diagnose and manage.

Why Exercise is Key (and Often the Best Medicine)

Exercise can be beneficial in managing both endometriosis and adenomyosis. It can help reduce pain, increase energy levels, and enhance mental well-being. For individuals with endometriosis, physical activity may decrease inflammation, improve flexibility, and alleviate muscle tightness and stiffness caused by adhesions. However, it’s important to note that higher-intensity exercise may lead to symptom flare-ups in some people.

For adenomyosis, exercise is particularly helpful for easing menstrual cramping, pelvic discomfort, fatigue, and low mood, but it does not address heavy menstrual bleeding, which is a defining feature of the condition. In both conditions, low- to moderate-intensity exercise that is tailored to symptoms and adjusted during flare-ups is generally best tolerated and is most effective when used alongside medical management.

Current exercise guidelines suggest aiming for around 150 minutes of moderate-intensity activity per week, or 75 minutes of vigorous activity, or a mix of both. It’s also important to include strength or resistance training at least twice a week, making sure to allow a day of rest between sessions.

Getting the recommended amount of exercise can be difficult, especially when you’re in pain. We have Exercise Physiologists who are trained to guide and support you through exercising with adenomyosis and/or endometriosis. If you are interested in extra support through exercise therapy, give us a call today or book a consultation. We are here to help you live better.

 

For further information, check out these sources.

https://drlenkliman.com.au/articles/uterine-adenomyosis-versus-pelvic-endometriosis/

https://endometriosisaustralia.org/move-to-improve-the-benefit-of-exercise-for-endometriosis/

https://exerciseismedicine.com.au/wp-content/uploads/2021/05/EIM-FactSheet_Endometriosis_Profession…