A 40-year-old woman with a 14-week size uterus due to diffuse adenomyosis has completed her family. She has failed medical management with a levonorgestrel intrauterine system and oral tranexamic acid, and continues to have severe menorrhagia with hemoglobin of 7.8 g/dL. The definitive management is:
- A Total hysterectomy ✓
- B Uterine artery embolization
- C Hysteroscopic endometrial ablation
- D Gonadotropin-releasing hormone agonist therapy for 6 months
Correct answer: A. Total hysterectomy
Explanation
Total hysterectomy is the definitive curative treatment for adenomyosis when medical therapy has failed and fertility is not desired. Unlike fibroids, adenomyosis has no clear tissue plane for conservative surgery, and local excision is generally not feasible for diffuse disease. UAE and endometrial ablation provide incomplete relief. GnRH agonists are temporary measures and do not constitute definitive management.
Reference: Comprehensive Gynecology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.