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PubMed This is a summary of 61 peer-reviewed journal articles Updated
Gynecology · Uterine Adenomyoma

Uterine Adenomyoma: A Patient Guide

At a Glance

Uterine adenomyoma is a benign, localized mass made from uterine lining and muscle tissue that may cause heavy bleeding and painful periods. Diagnosis often needs tissue testing, and treatment depends on symptoms, fertility goals, and whether the atypical variant is present.

A diagnosis of uterine adenomyoma often brings a mix of relief and new questions. This condition occurs when the tissue that usually lines the uterus (the endometrium) and the muscle of the uterine wall (the myometrium) grow together to form a distinct, localized mass [1]. While it is a benign (non-cancerous) growth, its “biphasic” nature—meaning it is composed of two different types of tissue—sets it apart from more common issues like uterine fibroids, which are made almost entirely of muscle [2]. Because these conditions can look similar on an ultrasound, reaching a definitive diagnosis often requires specialized imaging and a pathology review of a tissue sample, usually obtained through a procedure such as a hysteroscopy or a deeper surgical excision depending on the mass’s location [3][4].

Living with an adenomyoma often means managing significant symptoms, most notably abnormal uterine bleeding (AUB) and painful periods [5]. In some cases, the bleeding can be heavy enough to cause anemia, leading to exhaustion and weakness that require medical intervention [6]. While these symptoms can be life-altering, they are typically managed through a range of options, from hormonal medications that thin the uterine lining to surgeries that completely remove the localized mass [7]. For many, the goal is to find a balance between symptom relief and, if desired, preserving the ability to become pregnant in the future [4].

A critical focus for many patients is a specific variant known as atypical polypoid adenomyoma (APA) [8]. While still considered a benign tumor, the “atypical” label means the cells inside the growth have features that require more careful expert attention. APAs are recognized for having a low malignant potential, which means that although they are not cancer, they have a higher chance of returning after surgery or, in some cases, being associated with concurrent or future endometrial hyperplasia or cancer [9][10]. Published percentages for this risk vary based on how patients were selected. For this reason, patients with the atypical variant often enter a period of personalized, long-term surveillance involving regular check-ups and biopsies to ensure their health remains stable [11].

Ultimately, the path forward is guided by your specific symptoms, your pathology results, and your personal priorities for the future. While a hysterectomy is the definitive way to eliminate the uterus and its long-term risks, complete excision of a focal adenomyoma can be a definitive treatment for the mass itself, and many patients successfully manage their health through less invasive treatments and dedicated monitoring [12]. By working closely with a medical team that understands the nuances of this rare condition, you can develop a plan that addresses both the physical symptoms and the long-term protection of your uterine health [13].

In this guide

7 chapters

01

Understanding Uterine Adenomyoma

Learn what uterine adenomyoma means, how it differs from fibroids and adenomyosis, why pathology is needed, and why atypical polypoid adenomyoma needs monitoring.

02

Symptoms and Warning Signs

Learn the symptoms of uterine adenomyoma, including heavy bleeding, pelvic pain, anemia warning signs, and when to seek urgent or emergency medical care.

03

The Pathology Report: Deciphering the Map

Learn how to read your uterine adenomyoma pathology report, including APA, pushing versus infiltrative growth, p16 and SATB2 stains, margins, and cancer mimics.

04

Imaging and Preoperative Diagnosis

Learn how ultrasound, MRI, hysteroscopy, and biopsy help evaluate uterine adenomyoma before surgery, including MUSA signs, biopsy limits, and lesion location.

05

Treatment Options and Managing Symptoms

Learn how uterine adenomyoma treatments manage bleeding and pain, covering medicines, uterus-sparing surgery, hysterectomy, and atypical polypoid adenomyoma care.

06

Fertility Preservation and Pregnancy Outcomes

Learn about fertility-sparing treatment for atypical polypoid adenomyoma, pregnancy planning, recurrence risks, cancer monitoring, and birth complications.

07

Monitoring and Long-Term Surveillance

Learn how atypical polypoid adenomyoma surveillance works, including hysteroscopy, biopsies, warning symptoms, metabolic health, and surgery decisions.

Common questions in this guide

What is uterine adenomyoma, and is it cancer?
Uterine adenomyoma is a benign, localized mass made of uterine lining tissue and uterine muscle. It is not cancer, but the atypical polypoid variant has low malignant potential and may recur or be associated with endometrial hyperplasia or cancer, so closer follow-up is often recommended.
How is uterine adenomyoma diagnosed?
Uterine adenomyoma can resemble a fibroid on ultrasound, so imaging alone may not provide a definite diagnosis. A pathology review of tissue obtained through hysteroscopy or surgical excision is often needed, with the procedure chosen according to the mass’s location.
What symptoms can uterine adenomyoma cause?
Common symptoms include abnormal or heavy uterine bleeding and painful periods, which may include pelvic pain. Heavy bleeding can lead to anemia and cause exhaustion or weakness.
What treatments are available for uterine adenomyoma?
Treatment may include hormonal medication to reduce bleeding, complete surgical removal of the localized mass, or hysterectomy. The choice depends on symptoms, the mass’s location, pathology results, and whether preserving fertility is important to you.
What does atypical polypoid adenomyoma mean for follow-up?
Atypical polypoid adenomyoma is still considered a benign tumor, but its cells have features that warrant closer attention. Because it can recur and may be associated with endometrial hyperplasia or cancer, follow-up may include personalized check-ups and regular biopsies.
Can treatment for uterine adenomyoma preserve fertility?
Fertility preservation can be included in treatment planning. Some patients may be candidates for localized excision or other uterus-preserving management instead of hysterectomy, but the safest option depends on the mass, pathology, symptoms, and reproductive plans.

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References

References (13)
  1. 1

    Detection of MED12 mutations in mesenchymal components of uterine adenomyomas.

    Kito M, Maeda D, Kudo-Asabe Y, et al.

    Human pathology 2021; (109()):31-36 doi:10.1016/j.humpath.2020.11.013.

    PMID: 33259844
  2. 2

    Adenomyoma With Pseudoinvasive Growth Pattern and Serosal Penetration Mimicking Endometrial Carcinoma.

    Raj T, DeWitt R, Smith NE

    International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2018; (37(4)):397-400 doi:10.1097/PGP.0000000000000421.

    PMID: 28700437
  3. 3

    Imaging Diagnosis of Adenomyosis.

    O'Shea A, Figueiredo G, Lee SI

    Seminars in reproductive medicine 2020; (38(2-03)):119-128 doi:10.1055/s-0040-1719017.

    PMID: 33197946
  4. 4

    Atypical polypoid adenomyoma follow-up and management: Systematic review of case reports and series and meta-analysis.

    Biasioli A, Londero AP, Orsaria M, et al.

    Medicine 2020; (99(26)):e20491 doi:10.1097/MD.0000000000020491.

    PMID: 32590732
  5. 5

    [Atypical polypoid adenomyoma of the uterus: a clinicopathological review of 27 cases].

    Bai TJ, Bao DM, Li Y, et al.

    Zhonghua fu chan ke za zhi 2017; (52(4)):244-248 doi:10.3760/cma.j.issn.0529-567X.2017.04.006.

    PMID: 28441840
  6. 6

    Multimodal imaging in the diagnosis of uterine polypoid adenomyoma: a case report.

    Davis AJ, Gomez E

    BJR case reports 2026; (12(4)):uaag029 doi:10.1093/bjrcr/uaag029.

    PMID: 42495161
  7. 7

    Guideline No. 437: Diagnosis and Management of Adenomyosis.

    Dason ES, Maxim M, Sanders A, et al.

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2023; (45(6)):417-429.e1 doi:10.1016/j.jogc.2023.04.008.

    PMID: 37244746
  8. 8

    Surgical treatment of a rare case of atypical polypoid adenomyoma of the uterus in a menopausal patient: a case report.

    Thanasa EI, Thanasa AI, Paraoulakis IE, et al.

    The Pan African medical journal 2023; (44()):118 doi:10.11604/pamj.2023.44.118.39256.

    PMID: 37275297
  9. 9

    Hysteroscopic Transcervical Resection for Atypical Polypoid Adenomyoma of the Uterus: A Valid, Fertility-Preserving Option.

    Chiyoda T, Lin BL, Saotome K, et al.

    Journal of minimally invasive gynecology 2018; (25(1)):163-169.e1 doi:10.1016/j.jmig.2017.08.659.

    PMID: 29038039
  10. 10

    Stromal p16 and SATB2 Expression Does Not Distinguish Atypical Polypoid Adenomyoma (APA) From its Benign Mimics.

    Bui CM, Azimpouran M, Balzer B, et al.

    International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2024; (43(6)):586-594 doi:10.1097/PGP.0000000000001023.

    PMID: 38833724
  11. 11

    Management of women with atypical polypoid adenomyoma of the uterus: A quantitative systematic review.

    Raffone A, Travaglino A, Saccone G, et al.

    Acta obstetricia et gynecologica Scandinavica 2019; (98(7)):842-855 doi:10.1111/aogs.13553.

    PMID: 30714089
  12. 12

    The Present and the Future of Medical Therapies for Adenomyosis: A Narrative Review.

    Moawad G, Youssef Y, Fruscalzo A, et al.

    Journal of clinical medicine 2023; (12(19)) doi:10.3390/jcm12196130.

    PMID: 37834773
  13. 13

    Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two-center experience.

    Casadio P, Raffone A, Travaglino A, et al.

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2022; (159(1)):79-85 doi:10.1002/ijgo.14077.

    PMID: 34921691

This page is for informational purposes only and does not constitute medical advice about uterine adenomyoma. Your gynecologist and pathologist can interpret your results and recommend care based on your symptoms, fertility goals, and follow-up needs.