🌸 Adenomyosis & Endometriosis — Case Presentation

🧍‍♀️ Patient Background

• 38-year-old woman
  
  

• Mother of two (ages 7 and 9)
  
  

• Generally fit and well
  
  

• Obstetric history:
  
  

  • 1 planned Caesarean section
    
    

  • 1 normal vaginal delivery
    
    

🩺 Presenting Complaints

• Gradual onset lower abdominal/pelvic pain a few years after her last pregnancy
  
  

• Pain worsened progressively over several years
  
  

• Dysmenorrhoea (increasingly painful periods)
  
  

• Menstrual cycles slightly prolonged
  
  

• Heavy bleeding
  
  

• Daily pelvic discomfort, affecting work and daily functioning
  
  

• Deep dyspareunia
  
  

• Pain is now present outside menstruation
  
  

🧠 Patient Experience

• Feels misunderstood and unheard
  
  

• Multiple GP visits
  
  

• Several ultrasounds reported “nothing sinister”
  
  

• Emotional impact: frustration, anxiety, fatigue
  
  

• Represents millions of women silently suffering from these chronic conditions
  
  

🌍 Epidemiology

Endometriosis

• Affects ~10% of women globally
  
  

• Approx. 190 million worldwide
  
  

Adenomyosis

• Estimated in 20–30% of women
  
  

• More common in women with prior pregnancies
  
  

⚕️ Clinical Concerns & Diagnostic Clues

• Pain outside menses → suggests deeper disease or adenomyosis
  
  

• Heavy bleeding + dysmenorrhoea + deep dyspareunia
  
  

• Daily non-cyclical pelvic pain
  
  

• Subfertility
  
  

  • She has been trying for pregnancy for 18 months without success
    
    

🧑‍⚕️ Examination Findings

• Bulky, globular uterus → classic sign of adenomyosis
  
  

• Localised pelvic tenderness
  
  

• No adnexal masses on bimanual examination
  
  

🔎 Investigations

Ultrasound

• May appear normal (as in this case)
  
  

• Clues may include:
  
  

  • Heterogeneous myometrium
    
    

  • Asymmetrical uterine walls
    
    

  • Small myometrial cysts
    
    

MRI

• Best modality to confirm adenomyosis
  
  

• Junctional zone thickening >12 mm
  
  

• Myometrial cysts
  
  

• “Venetian blind” shadowing
  
  

Blood Tests

• CA-125 may be mildly elevated
  
  

• FBC to assess anaemia due to heavy bleeding
  
  

🧬 Differential Diagnosis ?

🩹 Management ?

🌱 Impact on Fertility ?