A 45-years-old multipara presents with dysmenorrhea and menorrhagia.Uterus is symmetrically enlarged up to 14 weeks. What is the probable diagnosis?: (A) Intramural fibroid, (B) Adenomyosis, (C) Endometrial hyperplasia, (D) Pelvic inflammatory disease
Answer is B. AdenomyosisCommon in women above 40 years.Often co-exists with fibroid, endometriosis and endometrial cancer.Uterus is symmetrically enlarged to not more than 14 weeks size.Histology - Islands of endometrial glands surrounded by stroma seen in the myometrial tissue beyond the endomyometrial junction.The distance between basal endometrium and the endometrial gland should be > 2.5 mm.Common complaint--Menorrhagia and progressive dysmenorrhoea.Clinical examination reveals symmetrical enlargement of uterus and tender uterus.Treatment is localized excision, hysterectomy.Medical treatment includes danazol, GnRH, Mirena IUCD.(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 407, 475)