Snapshot A 35-year-old woman with a long history of heavy menses and cramps presents with progressively worsening symptoms over the course of a few month. She has also gained weight. During the interview, she asked about the use of hormonal contraception. On physical exam, the uterus was enlarged, smooth, boggy, and tender. She elected to treat with hormonal contraceptives to preserve fertility instead of undergoing hysterectomy. Overview Introduction Invasion of endometrial glands into uterine myometrium Pathogenesis largely unknown hyperplasia of basalis layer of endometrium Epidemiology women ages 35-50 Associated conditions often coexists with other uterine diseases leiomyomas endometriosis Presentation Symptoms dysmenorrhea menorrhagia Physical exam uterus is uniformly smooth large soft globular boggy tender Evaluation nitial test to order in patient with enlarged uterusI β-hCG Diagnosis is based on clinical history and exam Imaging sonogram shows diffusely enlarged uterus with some cystic areas within myometrium Definitive diagnosis with hysterectomy and histology Differential Diagnosis Leiomyoma Pregnancy Endometrial polyp Treatment Symptomatic treatment for dysmenorrhea hormonal contraceptives e.g., levonorgestrel-releasing intrauterine contraception When fertility is no longer needed or failure of medical management hysterectomy Complications Controversial evidence linking adenomyosis with infertility
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RP.13.1) A 40-year-old female presents to her gynecologist with dysmenorrhea, menorrhagia, and pelvic pain. The patient is not taking any medication and has no evidence of fever. Transvaginal sonogram reveals an enlarged, soft, and tender uterus, and uterine biopsy shows normal-appearing endometrial glands within the myometrium. Which of the following is the most likely diagnosis in this patient: Tested Concept QID: 101664 Type & Select Correct Answer 1 Adenomyosis 51% (22/43) 2 Endometriosis 21% (9/43) 3 Endometritis 12% (5/43) 4 Leiomyoma 9% (4/43) 5 Endometrial carcinoma 0% (0/43) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK