You’re not imagining it
Adenomyosis pain is often dismissed as “normal” period pain, or “just part of being a woman”, by healthcare providers, friends and family. This repeated pain, the physical sensation, anticipating it and the surrounding burden that comes with it time and time again doesn’t go without harm. Recent studies are showing that the constant battle physically changes your brain structure. So yes, it’s serious, and yes, it’s worthy of proper care. We hope that bringing this study into the light will:
1) Give you evidence to help advocate for the care you deserve
2) Make providers think twice about minimising women’s pain
The Study: Brain Alterations in Adenomyosis-associated Pain
Researchers recruited 51 people with adenomyosis-associated dysmenorrhea (painful periods) and 51 demographically matched people without it, between 2023 and 2024 (1). The adenomyosis group completed an assessment to evaluate pain, and all participants also completed anxiety and depression scales because the researchers wanted to see whether any brain changes were tied specifically to physical pain, to distress, or to both. After, everyone had an MRI so researchers could compare their brain structure.
The Severity and Burden of Pain
Before brain MRI scans were even evaluated, researchers were already starting to see differences in the questionnaire scores alone. The adenomyosis group reported an average pain score of 7.75 out of 10, and had been living with that pain for an average of 5.65 years.
They also scored significantly higher on both anxiety and depression than the control group (1). Specifically, the adenomyosis group scored 20.51 on anxiety (HAMA scale) and 22.82 on depression (HAMD scale) compared to 3.94 and 4.94 in the control group, respectively. Years of enduring severe, cyclical pain drives a significant mental health burden , and the questionnaires alone made that plain.
The Physical Brain Changes
When it came to the MRI results, compared to controls, those with adenomyosis showed significantly reduced grey matter volume in key brain areas:
◉ Right fusiform gyrus
◉ Right parahippocampal gyrus
◉ Left superior frontal gyrus
Compared to controls, those with adenomyosis had significantly increased grey matter volume in these brain areas:
◉ Right lingual gyrus
◉ Bilateral thalamus
Healthy grey matter volume in these regions is what keeps pain signals gated, neurochemicals balanced, and the brain’s stress responses regulated. When volume is altered,protective mechanisms may break down.
Meet the Brain Regions Involved, and Understand Why They Matter
Regulating pain
The left superior frontal gyrus sits in the upper part of the prefrontal cortex and is involved in regulating pain. It also helps modulate key brain chemicals, including GABA, your calming neurotransmitter, dopamine, tied to motivation and reward, and glutamate, your brain's main excitatory signal. Losing grey matter here may offset that chemical balance and weaken the prefrontal cortex's ability to turn pain signals down over time, which researchers link to the overlap between chronic pain, low mood and cognitive difficulties (1).
Gatekeeping pain signals
The bilateral thalamus is essential for gatekeeping pain signals - both what’s sensed and felt. Chronic pain is associated with reduced levels of inhibitory GABA in the thalamus. This loss of inhibition disrupts the thalamus’ firing patterns which makes the volume turn up and send out continuous pain signals.
Memories of pain and affective processing (how pain is felt, not just where it hurts)
The right parahippocampal gyrus is part of your limbic system, and it contributes to memory of pain, how distressing pain feels,and pain modulation. When it holds less grey matter, the researchers suggest, the brain's ability to process how pain feels, and to store memories of it may be impaired in response to repeated pain episodes, which could feed into heightened pain sensitivity and “pain catastrophising” - this word sounds “oh so dramatic” but scientifically it actually means where the brain dwells on, anticipates and feels helpless against pain it knows is coming back - a real experience when someone endures relentless pain (1).
Integrating the Felt Experience of Pain (i.e. its weight, and it’s toll)
The right fusiform gyrus is best known for facial and visual recognition, but recent research points to a second role. It appears to help integrate the cognitive and distressing dimensions of pain, partly through its involvement in the brain's default mode network, which becomes active during pain perception (1). The default mode network is your internal brain network that isn’t focused on the outside world and is active during daydreaming, social cognition and self reflection. With less grey matter here, some of the brain's capacity to process the weight and toll of pain may become diminished over time.
Pain Empathy
Both the parahippocampal gyrus and the fusiform gyrus are critical to visual processing. Recurrent menstrual pain sensitises regions involved in pain empathy, which recruit these structures in the brain to allow someone to see, relate and aid those in agony (1). Loss of grey matter volume in these regions may reflect a state of hypersensitive visual pain empathy and a nervous system stuck in overdrive.
The takeaway
This study highlights that adenomyosis pain is not invented in your head, and is associated with measurable differences in brain structure in regions involved in multiple dimensions of pain. This reflects dysfunctional pain processing that can go from transient to chronic, from cyclical to constant, and creates a real, biological toll.
This starts in the clinic, when you are young. Clinicians must take dysmenorrhea and its potential underlying causes seriously, as without proper care and mitigation, this pain can become more complex to treat.
References
1. Wu Y, Chen Z, Liang M, Li J, Xiao W, Chen Y, Li R, Yu K, Wei W. Gray matter alterations and pain-related emotional processing in patients with adenomyosis-associated dysmenorrhea: a neuroimaging perspective. Quant Imaging Med Surg. 2025 Nov 1;15(11):11012-11021. doi: 10.21037/qims-2025-764. Epub 2025 Oct 10. PMID: 41209234; PMCID: PMC12591739.
