The bleeding wasn't normal. Neither was the cramping.

In endometriosis the rogue tissue grows outside the uterus, on ovaries, bowel, bladder. In adenomyosis it's the same kind of tissue but inside the muscle of the uterus itself (the myometrium). Each cycle it responds to estrogen, builds, and tries to shed, but it's trapped inside muscle, so the result is a uterus that becomes enlarged, boggy and inflamed. That's why the cramping feels different from a normal period: it's the uterus contracting around tissue that has nowhere to go.

Heavy menstrual bleeding (soaking pads or tampons hourly, flooding, large clots, anything bigger than a 50p coin or a US quarter) plus severe cramping plus a uterus that feels heavy and tender even between periods is the textbook adeno picture. Many women describe the cramping as 'labour-like' rather than 'period-like'. If two of three are true and they're getting worse, this deserves imaging.

Adenomyosis has fairly characteristic features on transvaginal ultrasound and MRI: a bulky uterus, thickened junctional zone, small cysts in the muscle wall, asymmetric uterine walls. A good MRI is the most accurate non-surgical diagnosis. A 'normal scan' from a non-specialist sonographer doesn't rule it out, ask specifically for an adenomyosis-aware ultrasound or MRI.

Estrogen swings get bigger and more erratic in your 40s, and adeno is estrogen-fed. Many women see the bleeding get heavier, the clots get bigger, and the cramping get longer in perimenopause, sometimes leading to a long-overdue diagnosis. It often quietens after menopause when estrogen drops, but not always (fat tissue keeps making estrogen, and HRT can re-activate it).

They're sister conditions and they often co-exist. If you have severe period pain, pain with sex, cyclical bowel or bladder symptoms, that's the endo overlap, and it deserves looking into too. The full sibling story is in the endometriosis & adenomyosis guide; this page is the adeno-specific tracking companion.

This is the single biggest practical difference from endometriosis. Adenomyosis lives in the uterine wall, so removing the uterus removes the disease. For women who are done with the uterus, hysterectomy resolves adeno completely. For women who want to keep the uterus, uterine-sparing options exist (adenomyomectomy, uterine artery embolization), but they're specialist territory and they're not first-line.

Count pad/tampon changes per day. Note 'flooding' (clothes/sheets through), having to double up, getting up in the night to change protection, or being unable to leave the house on heavy days. 'Heavy menstrual bleeding' clinically = soaking through one pad/tampon per hour for several consecutive hours, OR a bleed that interferes with normal life. Either threshold deserves investigation. Use the tracker on /symptoms with the 'Adenomyosis flare' chip, log volume in the notes.

Note clots bigger than a 50p coin (UK) or a US quarter / 2.5cm. These are clinically significant and a classic adeno flag. Track how many days of your bleed have large clots, and roughly how many per day. 'A few small clots once' is normal; 'fist-sized clots multiple times a day for four days' is not, and the difference is what the scan referral hinges on.

Pain score 1 to 10, when it starts (days before bleeding, day of, throughout), and what it stops you doing (work, sex, exercise, sleep). For adeno specifically, note if the cramping feels deep, low, and contraction-shaped (rising-and-falling, like labour) rather than the steady ache of a normal period. That description in your tracker is the one that makes a doctor or specialist sit up.

Bleeding for 8+ days, or cycles consistently shorter than 24 days, are both red flags for adeno (and more broadly for needing investigation in perimenopause). Track first day to last day of every bleed and how many days between cycle starts. Even rough numbers, kept consistently, are useful.

A uterus that feels heavy, full, or low-cramping even when you're not bleeding is one of the most distinctive adeno experiences, and one of the least asked-about. Note days where you feel it. This is the kind of detail doctors or specialists don't think to ask for and that points squarely at adeno over a generic 'heavy periods' workup.

Heavy bleeding from adeno causes iron-deficiency anemia routinely, and it's often what's making you feel terrible day-to-day on top of the bleeding itself. Track exhaustion, breathlessness on stairs, dizziness on standing, brain fog. Ask for ferritin (not just hemoglobin) at your next bloods, low ferritin with normal hemoglobin still warrants treatment.