Endometriosis vs. Adenomyosis: What's the Difference, and Why Does It Matter?

If you've ever been told you have endometriosis, or if you've been living with painful periods and a gut feeling that something is wrong, you may have come across the word adenomyosis and wondered: what exactly is the difference?

I get this question often. And I think it's worth answering thoughtfully, because these two conditions are frequently confused, frequently co-diagnosed, and frequently dismissed. Understanding what's actually happening in your body is the first step toward getting the care you deserve.

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What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the endometrium (the lining of the uterus) grows outside of the uterus. It might be found on the ovaries, the fallopian tubes, the bladder, the bowel, the pelvic sidewall, or, in rare cases, even further away from the pelvis.

This tissue responds to your hormonal cycle the same way the uterine lining does: it thickens, and then tries to shed. But unlike the uterine lining, it has nowhere to go. Over time, this creates inflammation, adhesions, and scar tissue that can affect the function of the organs and structures it surrounds.

Common symptoms of endometriosis include:

• Painful, heavy, or irregular periods

• Pelvic pain that is not limited to your period

• Pain with sex, particularly deep penetration

• Painful bowel movements or urination, especially during your period

• Bloating (sometimes called "endo belly")

• Difficulty conceiving

One critically important thing to understand: pain severity does not predict disease severity. Some women with extensive endometriosis have mild symptoms. Others with minimal visible disease are in significant pain. This is why endometriosis is so frequently underdiagnosed, often for a decade or more.

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What Is Adenomyosis?

Adenomyosis is sometimes called "internal endometriosis," but it's a distinct condition. In adenomyosis, the endometrial-like tissue grows into the muscular wall of the uterus itself (the myometrium), rather than outside of it.

This causes the uterine muscle to thicken and enlarge. The uterus works harder during menstruation, which often translates to:

• Very heavy or prolonged periods

• Intense menstrual cramping

• A feeling of pressure, fullness, or heaviness in the pelvis

• Uterine tenderness

• Discomfort with sex

Adenomyosis can be diffuse (spread throughout the uterine wall) or focal (concentrated in one area, sometimes forming a pocket called an adenomyoma). It is most commonly diagnosed in women in their 30s and 40s, often after childbearing, though it can occur earlier.

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Can You Have Both?

Yes, and it's not uncommon. Research suggests that a significant percentage of women with endometriosis also have adenomyosis, though historically adenomyosis was only diagnosable after a hysterectomy. Improvements in MRI imaging have made it possible to identify adenomyosis noninvasively, though it still goes unrecognized far too often.

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Where Pelvic Floor PT Comes In

Neither endometriosis nor adenomyosis is cured by pelvic floor physical therapy. I want to be clear about that. Both conditions require comprehensive medical management, and I work closely with OBGYNs, gynecologic surgeons, and integrative providers to support my patients through their full treatment journey.

But chronic pain, inflammation, and surgical intervention all leave a mark on the pelvic floor and surrounding tissue. That's where I come in.

For women with endometriosis or adenomyosis, pelvic floor PT can:

• Address the compensatory tension patterns that develop in response to chronic pain

• Release scar tissue and adhesions after excision surgery or other procedures

• Improve pelvic organ mobility and function

• Reduce pain with sex, bowel movements, and daily movement

• Support a return to exercise, work, and quality of life

If you've had surgery for endometriosis and are still in pain, or if you've been managing symptoms for years without relief, your pelvic floor is likely part of the story. And that part has a solution.

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You Deserve a Complete Answer

If you've been told your painful periods are normal, or if you've been dismissed when you've pushed for answers, I want you to hear this clearly: significant pelvic pain is not a normal part of having a uterus. You deserve a diagnosis. You deserve a team. And you deserve a treatment plan that sees all of you.

Ready to take the first step? Book your free consultation at https://app.pteverywhere.com/woven/bookingonline. Woven Pelvic Health and Wellness is located in Denver, CO and serves women throughout the Denver metro area.

Dr. Ashley Castellanos, PT, DPT is the owner and founder of Woven Pelvic Health and Wellness in Denver, Colorado. She specializes in pelvic floor physical therapy for women across all stages of life, with advanced training in manual therapy, dry needling, orthopedics, and trauma-informed care..