I am a public health practitioner working in women’s health. I am also a woman. Those two facts sit in the same body, and they do not always agree with each other.
When I visit my gynaecologist, I rarely leave on time. I ask too many questions. I follow the answers into places most appointments do not have room for. Part of that is temperament. Most of it is what I carry from working in this field, where I have watched women describe pain that the system has trained itself not to hear.
Adenomyosis is one of those places the conversation rarely reaches.
Say the word out loud and watch what happens. People pause. They ask you to repeat it. Many have heard of endometriosis, and a few can describe it. Adenomyosis lands as something new, even among women who have lived with its symptoms for years. That gap between how common the symptoms can be and how rarely the condition is named carries the whole story.
Let me explain it plainly. Adenomyosis happens when tissue similar to the lining of the uterus grows into the muscular wall of the uterus itself. It can cause heavy bleeding, deep menstrual pain, chronic pelvic pain, an enlarged uterus, and exhaustion that many women carry while being told their periods are simply difficult. Some women may also experience fertility challenges, while others may have few or no symptoms at all. That variation is part of what makes the condition so easy to miss.
Here is what unsettles me as a practitioner. Adenomyosis has been recognized in medical literature for more than a century, yet for much of that time, the most certain diagnosis came only after hysterectomy, when the uterus could be examined directly. Think about what that means. For generations, the clearest confirmation often came after a woman had already lost the organ at the centre of the pain. Imaging has shifted the standard of practice. Transvaginal ultrasound and MRI can now support diagnosis without surgery, but they offer probability, not certainty, and only when the tools are available, the signs are recognized, and the person interpreting the results knows what to look for. In many health systems across Africa and beyond, that level of access still sits far out of reach.
Women wait, and the waiting compounds. They are told their pain is normal. They adjust their lives around it. They learn to plan their months around bleeding they cannot predict. Years pass before anyone names the condition, and a good deal of trust has been spent along the way.
I keep returning to one question. Who failed them?
The honest answer is that the failure is shared, and it runs through every level of the system. Research and funding decided long ago that this pain sat low on the list, and the science moved too slowly. Medical training has not equipped enough clinicians to recognize the condition early or to hold the conversation with care. Health systems offer no clear pathway, and they rarely measure whether a woman’s quality of life improves. Industry has too often followed the treatments that are easiest to package, rather than the care pathways women need across their reproductive lives. Families and communities’ taught generations of girls that suffering quietly was a form of strength.
Women themselves learned to doubt their own bodies. That last part is the one I want to handle gently, because it is real, and it carries no blame. You cannot name what no one gave you the words for.
This is why I think of it as a shared responsibility. The researcher, the clinician, the policymaker, the company, the community, and the woman who has been taught to wait each sit somewhere in this story. No single villain stands at the centre of it. A web of small refusals to act adds up to one woman in a waiting room, wondering whether she is imagining her own pain.
I am starting this series with adenomyosis for that reason. If we can learn to see the condition that hides best, we may also learn to see the systems that keep women’s pain unnamed for too long.
Endometriosis and perimenopause follow, and the same questions will travel with them. What did we know? Who should have acted? What do we owe the person living inside this body?
Over the coming weeks in June, I will sit with those questions. I hope you will sit with them too, not as observers, but as people who are part of the answer.