Adenomyosis and Pregnancy: Risks, Fertility and What to Ask

Yes, you can get pregnant with adenomyosis, and many people do. Adenomyosis is more common in people who have already given birth, but it can make it harder to get pregnant and can raise the risk of miscarriage.

In pregnancy, adenomyosis is linked to a higher chance of some problems, such as pre-eclampsia and preterm birth. Most of the research comes from observational studies that differ a lot from each other, so the size of each risk is not certain. This guide explains what the research shows, how treatment fits with plans to conceive, and what to ask your doctor.

Quick answer: what adenomyosis can change

Adenomyosis is when the tissue that lines the womb grows into the muscle wall of the womb. If you are not sure how it differs from endometriosis, read adenomyosis vs endometriosis.

The words "linked" and "higher risk" here mean the problems happen more often in groups of people with adenomyosis. They do not mean a problem will happen to you. Most of the studies differ a lot in how they were done, which makes the evidence hard to judge.

Fertility: getting pregnant with adenomyosis

Adenomyosis can affect fertility. Much of the data comes from people who had IVF or other fertility treatment.

In people who had fertility treatment, adenomyosis was linked to a lower chance of a clinical pregnancy and about twice the odds of miscarriage. These links stayed after the researchers allowed for age. A later review found the link to miscarriage again, but it rated that evidence as low quality.

Adenomyosis often comes with endometriosis. Some of the fertility and pregnancy problems that are seen in people with endometriosis may come from adenomyosis at the same time.

If you have tried to get pregnant for some time without success, ask for a referral to a fertility specialist. Tell them that you have adenomyosis or that a scan suggested it.

Pregnancy risks with adenomyosis

When you are pregnant, adenomyosis is linked to a higher chance of:

• Miscarriage. Reviews agree on this link.
• Pre-eclampsia. This is high blood pressure in pregnancy that can be serious. Two reviews found a higher risk with adenomyosis, also when they allowed for how the pregnancy started or looked only at IVF pregnancies.
• Preterm birth, a small baby for its age, a baby that lies in the wrong position, and heavy bleeding after birth. One review linked adenomyosis to all of these whether the pregnancy came from IVF or not.
• Caesarean birth. This was also more common with adenomyosis.

The evidence is not equal for each problem. A large 2024 review that pulled apart the effects of endometriosis, adenomyosis and IVF found that only miscarriage and pre-eclampsia stayed linked to adenomyosis in all of its checks, and it rated both as low-quality evidence.

How severe the adenomyosis is may matter. People with severe adenomyosis should be treated as having a high-risk pregnancy and can benefit from care at a specialist centre. For milder adenomyosis, it is not yet known if the same extra care is needed.

A higher risk in a study group is not a promise about your own pregnancy. Ask your doctor what your scans show and what extra checks make sense for you. Closer monitoring in pregnancy is often suggested.

Treatment and plans to get pregnant

The right treatment depends on your symptoms, your age and if you want to become pregnant. Tell your doctor early if you hope to get pregnant, now or later.

Hormonal treatment and the hormonal IUD

The hormonal IUD (Mirena, also called the IUS or hormonal coil) and other hormonal contraception can make periods lighter and less painful. They are also contraception, so you stop them when you start to try for a pregnancy. Our guide to Mirena for endometriosis and adenomyosis covers how soon fertility returns after removal.

Ask your doctor how to manage pain and bleeding while you try to conceive.

Surgery to remove adenomyosis (adenomyomectomy)

An adenomyomectomy removes the adenomyosis and keeps the womb. Across studies, about half of people who wanted a pregnancy got pregnant after this surgery. The same review found no randomised trials, and it warns that the evidence is limited and may be biased.

The surgery can weaken the wall of the womb. Pregnancies after adenomyomectomy have a higher rate of uterine rupture than after other womb surgery, and almost everyone in these studies gave birth by caesarean. If you had this surgery, tell every doctor and midwife in your pregnancy care.

Hysterectomy

Removing the womb is the only cure for adenomyosis, but after it you cannot get pregnant. If you may want a pregnancy in the future, ask about other options first.

IVF with adenomyosis

If you need IVF, ask your fertility clinic how adenomyosis may affect your plan. In one review, the lower chance of pregnancy with adenomyosis was larger with short IVF protocols. A longer course of medicine to switch off the hormones before IVF may help, but this still needs proof from trials.

Questions to ask your doctor

Write your questions down before the appointment. You can start with these:

1. How severe is my adenomyosis, and is it focal (in one area) or diffuse (spread through the wall)?
2. Does my adenomyosis change my chances of getting pregnant?
3. Should I see a fertility specialist now, or after how many months of trying?
4. When should I stop my hormonal treatment or IUD, and how do I manage pain after that?
5. Is surgery a good idea for me before I try, and how long should I wait after it?
6. If I need IVF, which protocol do you suggest, and why?
7. Will my pregnancy be treated as high risk, and which extra scans or blood pressure checks will I have?
8. If I had surgery on my womb, how will my baby be born?

What to track before and during pregnancy

A record of your symptoms helps your doctor see the pattern. Note your pain, how heavy your periods are, any bleeding between periods, and how symptoms affect your day. If adenomyosis makes your belly swell, our guide to adenomyosis belly explains what can cause it.

Endolog is a pain and symptom diary for endometriosis and adenomyosis. You log pain severity and where it hurts, bleeding, bloating and other symptoms with notes, and you can share a PDF report with your doctor. A paper notebook works too.

Get urgent help

Pre-eclampsia can start from 20 weeks of pregnancy, and sometimes in the days or weeks after birth. Call your maternity unit or doctor right away if you are pregnant or recently gave birth and you have any of these signs:

• A severe headache that does not go away with simple painkillers
• Problems with your vision, such as blurred vision or flashing lights
• Pain below the ribs
• Sudden swelling of the face, hands or feet
• Feeling very unwell, or vomiting

If you cannot reach your maternity unit, call your local urgent care line or emergency number.

FAQ: adenomyosis and pregnancy

Can you get pregnant with adenomyosis?

Yes. Adenomyosis can make it harder to get pregnant, but many people with adenomyosis get pregnant, with or without fertility treatment.

Is adenomyosis a high-risk pregnancy?

It can be. Severe adenomyosis is considered a high obstetric risk. For mild adenomyosis, it is not clear if extra care is needed. Ask your doctor or midwife what applies to you.

Does adenomyosis cause miscarriage?

Adenomyosis is linked to a higher risk of miscarriage, but a higher risk does not mean that your pregnancy will end in miscarriage.

Should I have surgery before I try to get pregnant?

Not always. Surgery has risks for a later pregnancy, such as uterine rupture. Talk through the pros and cons with a specialist before you decide.