A 45-year-old multipara presents with dysmenorrhoea and menorrhagia. Uterus is symmetrically enlarged upto 14 weeks. What is the probable diagnosis? (E. REPEAT 2008)
Intramural fibroid
Adenomyosis
Endometrial hyperplasia
Pelvic inflammatory disease
Ref: Shaw's Textbook of Gynaecology, 15th edition. Page 474 Explanation: ADENOMYOSIS * Common in women above 40 years. * Often co-exists with fibroid, endometriosis and endometrial cancer. * Uterus is symmetrically enlarged to not more than 14 weeks size. * Histology - Islands of endometrial glands surrounded by stroma seen in the myometrial tissue beyond the endomyometrial junction. * The distance between basal endometrium and the endometrial gland should be > 2.5 mm. * Common complaint--Menorrhagia and Progressive dysmenorrhoea. * Clinical examination reveals symmetrical enlargement of the uterus and tender uterus. * Treatment is localized excision, hysterectomy. * Medical treatment includes Danazol. GnRH, Mirena IUCD.
Gynaecological Diagnosis