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 login to view 2 more bullets Epidemiology login to view 1 more bullet Associated conditions login to view 3 more bullets Presentation Symptoms login to view 2 more bullets Physical exam login to view 7 more bullets Evaluation nitial test to order in patient with enlarged uterusI login to view 1 more bullet Diagnosis is based on clinical history and exam Imaging login to view 1 more bullet Definitive diagnosis with hysterectomy and histology Differential Diagnosis Leiomyoma Pregnancy Endometrial polyp Treatment Symptomatic treatment for dysmenorrhea login to view 2 more bullets When fertility is no longer needed or failure of medical management login to view 1 more bullet Complications Controversial evidence linking adenomyosis with infertility