A 42-year-old with menorrhagia, dysmenorrhoea, and a uniformly enlarged 14-week-size uterus. MRI shows heterogeneous myometrium with junctional zone thickness >12 mm and small myometrial cysts. She has completed her family and wants definitive treatment. The diagnosis and best treatment are:

• A Multiple fibroids; myomectomy is the definitive treatment
• B Adenomyosis; hysterectomy is the definitive treatment ✓
• C Adenomyosis; GnRH agonist therapy for 6 months then reassess
• D Diffuse endometriosis; laparoscopic ablation

Explanation

Adenomyosis is characterised by endometrial glands and stroma within the myometrium, causing a diffusely enlarged, boggy uterus. MRI criteria include junctional zone thickness >12 mm (highly specific) and myometrial cysts or heterogeneous myometrial signal. As this patient has completed her family and desires definitive treatment, hysterectomy is the only curative option. GnRH agonists provide temporary relief but symptoms recur on cessation. LNG-IUS and combined OCPs are medical temporising measures. Myomectomy is for fibroids, which cause a lobulated uterus with discrete nodules on MRI.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.