@Allromanticsmeetthesamefate She very likely has adenomyosis, particularly from the scan results. She could have endo, but you'll need further investigations for that. Also, it's important to have things to bring up, but this is early in the diagnostic process. Also, it could be other things, so don't narrow it into too much, too early. Wait for the biposy and scan results and see.
Heterogeneous means it doesn't look uniform so the texture appears patchy, speckled, or irregular.* There are two types of adenomyosis (focal - so like blobs across the uterine muscle or diffuse - small bits spread across all of it)*. There's also certain cysts, but that can occur with either). So something like speckled is likely more diffuse.
Adenomyosis is when the uterine lining invades deeper into the muscle. Adenomyosis is localised to the uterus only unlike endometriosis which is not in the uterus at all because it is by definition tissue similar but not the same as the endometrial lining across other organs in the body. So fallopian tubes, ovaries, bowels, bladder. It is different for every person.
Does she have any other symptoms? Like pain with sex and insertion to the vagina, severe vomiting and nauesa, constipation and/or diarrhoea.
I recommend trying the mirena as it will make the uterus lining thinner so there is less bleeding and less cramps as there's less blood vessels there. It will reduce the bleeding and often stops periods for some people over time. There are things like licodaine, numbing gel that can be done for insertion.
Also ask the GP for a higher mefenamic acid and/or naproxen or a different NSIAD (NSAIDs, which help a lot as they are anti-inflammatories and give pain relief). Some are better for some people than others.
For the heavy bleeding use tranexamic acid (helps reduce heavy bleeding).
In terms of possible conditions (cysts, endometriosis, etc). It is split into two overall types in gyne 1. Primary dysmenorrhea (heavy bleeding and painful periods with no condition or cause or 2. Secondary dysmenorrhea so a condition e.g endometriosis or adenomyosis causing it.
Then if ultrasounds pick up on anything (pelvic ultrasound or transvaginal) you may need to have an MRI to see endometriosis (more are able to do it now, especially with more training for consultant radiologists).
However, the only way for definite diagnosis is a laparoscopy and then they will often excise the endometriosis tissue if they find it etc. But endometriosis is a chronic illness and cannot be cured, after surgery it will grow back, it cannot be excised from everywhere to leave organ functioning intact and then post-surgery adhesions often form.
The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period.
Main endo symptoms:
• Irregular or heavy periods
• Pelvic pain
• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea and constipation)
• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes
• Referred pain to the tops of the legs or back
• Fatigue
Mangagement can look like pain medication depending on how severe your pain and symptoms are (can be opioids - often used more temporarily and obviously as little as possible, NSAIDs) and contraception and hormonal treatments.
The links below have much more detailed and useful information.
https://www.nhs.uk/conditions/adenomyosis/
https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/