A 38-year-old woman presents with heavy menstrual bleeding, dysmenorrhea, and a uniformly enlarged, tender uterus measuring 12 weeks size. She has completed her family. Ultrasound shows globular uterus with heterogeneous myometrium and cystic spaces. Serum CA-125 is 78 U/mL. What is the MOST likely diagnosis and definitive management?
- A Leiomyomatosis; myomectomy
- B Adenomyosis; hysterectomy ✓
- C Endometrial carcinoma; total hysterectomy + staging
- D Endometriosis; laparoscopic ablation
Correct answer: B. Adenomyosis; hysterectomy
Explanation
Adenomyosis presents with the classic triad of dysmenorrhea, menorrhagia, and a uniformly enlarged tender uterus (the globular 'bog-like' uterus). MRI/ultrasound showing heterogeneous myometrium with subendometrial cysts confirms the diagnosis. Mildly elevated CA-125 is common in adenomyosis. Hysterectomy is the definitive treatment for women who have completed childbearing; conservative options including LNG-IUS and GnRH agonists can temporize in those wishing to preserve fertility.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.