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Gynaecology · UK

Adenomyosis treatment, by a BSGE-accredited specialist.

A full ladder for heavy bleeding, severe period pain and subfertility caused by adenomyosis.

A stethoscope on a clinical desk

Indicative pricing

What private adenomyosis treatment costs in the UK.

Indicative ranges across UK private providers and hospitals.

In short

£280 to £14,000. Definitive laparoscopic hysterectomy: £11,000 to £18,500.

Treatment Indicative range
Initial gynaecology consultation (45 to 60 min) £280 to £450
MRI pelvis with junctional zone protocol £850 to £1,400
Mirena (LNG-IUS) insertion £280 to £450
Uterine artery embolisation (UAE) £6,500 to £11,000
HIFU for focal adenomyosis £8,500 to £14,000
Laparoscopic adenomyomectomy £14,000 to £24,000
Laparoscopic hysterectomy £11,000 to £18,500
Robotic hysterectomy £14,000 to £22,000

Prices vary by hospital, by consultant and by the extent of surgery. Robotic and adenomyomectomy cases sit at the higher end because of theatre time and disposables.

The journey

From first appointment to symptom review, in order.

One team from your first message to long-term follow-up, coordinating gynaecology, radiology, interventional radiology and fertility where needed.

  1. 03

    Before

    Consultation and imaging

    A 45 to 60 minute gynaecology consultation, transvaginal ultrasound in clinic, and MRI pelvis if the picture is unclear or surgery is on the table.

  2. 04

    On the day

    Your chosen treatment

    Mirena insertion in clinic, GnRH antagonist start, uterine artery embolisation in interventional radiology, HIFU day case, or laparoscopic or robotic surgery in theatre.

  3. 05

    On the day

    Recovery to plan

    Day case for Mirena, UAE and HIFU. One to three nights for laparoscopic hysterectomy or adenomyomectomy. Written aftercare and 24/7 contact.

  4. 06

    After

    Symptom review at 3 and 6 months

    A structured review of bleeding, pain and quality of life. MRI reassessment if UAE or HIFU was used. Fertility pathway handover if that was the goal.

  5. 07

    After

    Long-term follow-up

    Mirena review at 5 years. Menopause planning if oophorectomy was performed. Endometriosis and PCOS pathways linked in where they coexist.

When it helps

The common symptom patterns, and the red flags that need different care.

Adenomyosis affects around 20 to 35 percent of people of reproductive age, and often coexists with endometriosis and fibroids. These are the common presentations.

  • Heavy menstrual bleeding (menorrhagia)

    Flooding, clots, changing protection every hour, iron deficiency anaemia. The most common reason people seek help.

  • Severe period pain (dysmenorrhoea)

    Cramping that starts days before bleeding, needs strong analgesia and stops you working. Often worse than typical primary dysmenorrhoea.

  • Chronic pelvic pain outside periods

    A dull, dragging pelvic ache, dyspareunia and pain with bowel movements. Distinct from cyclical pain and often shared with endometriosis.

  • A boggy, tender, enlarged uterus

    A globular, softer, larger than expected uterus on examination or scan. Classic on transvaginal ultrasound alongside cystic myometrial changes.

  • Subfertility or recurrent IVF failure

    Adenomyosis is associated with lower implantation rates. A pre-transfer plan can matter for those going into IVF.

  • Coexisting endometriosis or fibroids

    Around a third of people with adenomyosis have endometriosis, and many have fibroids. A single plan covers all three where possible.

  • Failed first-line medical treatment

    Tranexamic acid, NSAIDs or the combined pill have not touched the symptoms. Time to escalate to LNG-IUS, GnRH antagonist or a procedure.

  • Red flag: post-menopausal bleeding

    Any bleeding after menopause needs urgent gynaecology assessment on a two-week-wait pathway, not a private booking.

Treatment options

A ladder from medical to definitive surgery.

Focal vs diffuse disease and your fertility plans set the path. Most patients start medical, escalate to a uterus-preserving procedure and only reach hysterectomy when they choose to.

  • LNG-IUS (Mirena)

    Local progestogen that thins the endometrium and calms the junctional zone. Reduces bleeding by 70 to 80 percent at one year. First-line for many, and often kept alongside other treatments.

  • GnRH antagonist with add-back (Ryeqo)

    Relugolix combined with oestradiol and norethisterone. Licensed for uterine fibroids and adenomyosis. Rapid bleeding and pain control without the flare of a GnRH agonist.

  • Dienogest (Visanne)

    A progestogen with strong endometriosis evidence and useful benefit in adenomyosis, particularly where pain dominates.

  • Uterine artery embolisation (UAE)

    Interventional radiology day case. Bilateral catheter-directed particulate embolisation reduces perfusion of adenomyotic tissue. Symptom relief comparable to hysterectomy in the right patient, uterus preserved.

  • HIFU (MRI or ultrasound guided)

    Non-invasive, incision-free thermal ablation. Best for focal adenomyosis in a favourable location. Can be repeated if needed.

  • Laparoscopic adenomyomectomy

    Keyhole excision of a discrete adenomyoma with reconstruction of the myometrium. Technically demanding. Subsequent pregnancies are usually planned for caesarean delivery.

  • Endometrial ablation (NovaSure)

    Bipolar radiofrequency ablation of the endometrium. Useful for menorrhagia in people who have completed their family. Not contraceptive and not curative for pain.

  • Laparoscopic or robotic hysterectomy

    Definitive treatment. Cures symptoms and gives the diagnosis on histology. Ovaries usually preserved unless there are separate indications or peri-menopause.

Safety and recovery

What to expect from each option, honestly.

Every rung of the ladder has trade-offs.

  • Mirena expulsion and irregular bleeding

    Around one in twenty Mirenas are expelled, most in the first year. Irregular spotting for the first three to six months is common and usually settles.

  • GnRH antagonist side effects

    Ryeqo is generally well tolerated because of the add-back. Occasional headache, hot flushes, mood change and reduction in bone density on longer courses, so monitoring is needed.

  • UAE risks

    Post-embolisation syndrome (pain, low-grade fever, malaise) for a few days. Premature ovarian insufficiency in around 5 to 10 percent. Not first choice if immediate fertility is planned.

  • HIFU limits

    Best for focal, accessible disease. Not suitable for extensive diffuse adenomyosis, bowel loops in the beam path, or scars in the target zone. Skin burn is uncommon.

  • Adenomyomectomy and pregnancy

    Excision can compromise myometrial integrity. Subsequent pregnancies are usually delivered by planned caesarean at 37 to 39 weeks to reduce uterine rupture risk.

  • Hysterectomy is definitive

    Cures symptoms and confirms the diagnosis on histology. Loss of fertility is permanent. Ovaries usually kept unless there is a separate reason to remove them.

  • Anaemia should be corrected first

    Iron infusion or oral iron before any procedure improves recovery and reduces transfusion risk, so it should be built into the plan.

  • Red flags after any procedure

    Heavy fresh bleeding, fever above 38 degrees, severe unremitting pain, offensive discharge or leg swelling. Call the unit or go to A&E the same day.

  • Fertility planning is a separate conversation

    If pregnancy is the goal, treatment order matters. Ultra-long GnRH agonist protocols before IVF have limited but promising evidence and are discussed case by case.

Reading your MRI report

Your adenomyosis MRI in four parts. Read the last one first.

MRI pelvis with a junctional zone protocol is the gold standard non-surgical test. Whichever scanner it was done on, the report keeps to the same shape.

  1. 01 Header

    Uterine size, shape and symmetry

    A globular, asymmetrically enlarged uterus with the anterior or posterior wall thicker than the other is the classic pattern.

  2. 02 Junctional

    Junctional zone thickness and definition

    Junctional zone thickening over 12 mm on MRI, or blurring on ultrasound, is the single most reliable imaging feature.

  3. 03 Findings

    Myometrial cysts, focal vs diffuse

    Small cystic spaces, hyperintense foci and echogenic buds. Focal disease (an adenomyoma) is treated differently to diffuse involvement.

  4. 04 Impression

    Coexisting endometriosis and fibroids

    Read this first: whether endometriosis or fibroids are also present, because a single operation or medical plan often addresses all three.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for adenomyosis treatment varies by insurer and by indication. Medical management, UAE and hysterectomy are usually funded when medically indicated.

Frequently asked

Common questions about adenomyosis.

Quick answers on diagnosis, uterus-sparing options, fertility and cost.

  • What is adenomyosis and how is it different from endometriosis?

    Adenomyosis is endometrial-like tissue growing within the muscular wall of the uterus. Endometriosis is the same tissue outside the uterus, on the peritoneum, ovaries or bowel. The two often coexist. Adenomyosis typically causes heavy bleeding and a diffuse, tender, enlarged uterus, while endometriosis is more often associated with focal pain and adhesions.

  • How is adenomyosis diagnosed without surgery?

    Transvaginal ultrasound in expert hands picks up the classic features: an asymmetrically enlarged uterus, myometrial cysts, junctional zone thickening and echogenic buds. MRI pelvis with a dedicated junctional zone protocol is the gold standard non-surgical test. Histology is definitive but only obtained if a hysterectomy is performed.

  • What are my treatment options if I want to keep my uterus?

    The uterus-preserving ladder includes the Mirena coil, GnRH antagonists such as Ryeqo, dienogest, uterine artery embolisation, HIFU and, for focal disease, laparoscopic adenomyomectomy. The right choice depends on whether bleeding or pain dominates, whether the disease is focal or diffuse, and your fertility plans.

  • How much does private adenomyosis treatment cost in the UK?

    A consultation is £280 to £450 and MRI pelvis £850 to £1,400. Mirena insertion is £280 to £450. Uterine artery embolisation is £6,500 to £11,000 and HIFU £8,500 to £14,000. Laparoscopic hysterectomy is £11,000 to £18,500 and robotic hysterectomy £14,000 to £22,000.

  • Does adenomyosis affect fertility?

    Adenomyosis is associated with lower implantation and higher miscarriage rates, particularly in IVF. If you are trying to conceive, treatment order matters. Options include the Mirena removed before conception, dienogest or Ryeqo courses, and an ultra-long GnRH agonist protocol for two to six months before embryo transfer.

  • When is hysterectomy the right answer?

    Hysterectomy is the definitive treatment and gives the diagnosis on histology. It is the right answer when symptoms are severe, medical and uterus-sparing treatments have failed or are unsuitable, and fertility is not desired. Laparoscopic or robotic routes give faster recovery than open surgery. Ovaries are usually preserved unless there is a separate indication.

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